The differential diagnosis will change according to the child’s age.
A febrile child with a limp, or a non-weight bearing child, needs same day assessment. Red flag features include high fever, weight loss, night pain and lethargy
A limp persisting beyond two weeks requires referral to paediatrics, paediatric rheumatology or paediatric orthopaedics.
Consider a history of trauma, including non-accidental injury, but be aware that children with pathology may be more prone to falling.
Ask about morning stiffness and joint swelling – consider inflammatory causes such as Juvenile Idiopathic Arthritis.
Be familiar with “normal” motor milestones. If motor development is delayed consider a CK test early
Many hip pathologies cause limp, but remember to assess other joints and think of extra-articular causes (including footwear and soles of feet for minor trauma or infection).
Growing pains never cause a limp.
History and examination will give you the likely differential diagnosis, but investigations may be helpful to exclude pathology. What investigations to do is influenced by the clinical context.
pGALS is a useful and quick tool to assess all joints and guide further detailed examination.
Please note: a pdf document of these Top Tips is also available here.
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