Pain crises are the most common SCA related presentation to the ED, and typically affect the long bones and back. They can be triggered by stress, extremes of cold, dehydration, hypoxia, or infection, but most often occur without a specific cause. In an individual patient, recurrent pain crises tend to be similar in location and quality to previous episodes. Although, typically, there are no physical findings, pain, local tenderness, swelling, and warmth may occur. Low-grade temperature elevations can occur, but true fever is rare. Infants and toddlers can present initially with dactylitis, a swelling of hands or feet, and low-grade temperature caused by ischemia and infarction of the bone marrow.