Indications for urgent (same day) assessment of limp - acute day unit / general paediatrics / paediatric rheumatology / orthopaedics - depending on your local referral pathways;
- the very young (under 3 years of age)
- the ill and febrile
- the non-weight bearing
- children with painful restricted hip movements
- the child who is immunosuppressed
Many units have limping child protocols, these often focus on hip pathology and it is important to consider general assessment and joints elsewhere.
Assessment will include history and examination, blood tests and imaging. These are covered in more detail under the red flag and key conditions.
It is important that a child with a limp has a follow up plan and parents have instructions for when to seek health care.
The child with limp that is not recovering, or is intermittent, needs further assessment, and before embarking on a series of investigations, especially if these may be invasive or incur delay, then consider referral to paediatric rheumatology. Many children with inflammatory joint or muscle disease have a history of intermittent limp without a clear diagnosis (see Pitfalls). Abnormal gait/limp may be due to muscle disease; consider referral to paediatric neurology.
Guidelines for a suggested approach to atraumatic limping child is available.