This website used cookies to give you the best experience. By continuing to use this website you are consenting to cookies being used. You can delete and block cookies from within your browsers settings. For more information please refer to our privacy and cookie policy page.

Continue

Limping

 The differential diagnosis of limp is wide and varies with age.

Limp is a symptom and not a diagnosis.

  • Red flag features include high fever, weight loss, night pain and lethargy. Infection and malignancy must be excluded.
  • A limp persisting beyond two weeks requires referral to paediatrics, paediatric rheumatology or paediatric orthopaedics (pending local referral pathways).
  • Morning stiffness (even if no obvious joint swelling) suggests inflammatory causes such as Juvenile Idiopathic Arthritis. Regression of motor milestones may be apparent.
  • 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).
  • Trauma including non-accidental injury, must be considered but it is noteworthy that children with pathology may be more prone to falling. 
  • Assessment will include history and examination, blood tests and imaging. 
  • It is important to examine all joints and not just the legs. pGALS is a useful and quick tool to assess all joints and guide further detailed examination. 
  • Motor milestones are important - if motor development is delayed consider a CK test early.
  • It is important that a child with a limp has a follow up plan and parents have instructions for when to seek health care advice.
Indications for urgent (same day) assessment of limp include the following: 
  • the very young (under 3 years of age).
  • the ill and febrile (red flags).
  • the non-weight bearing.
  • children with painful restricted hip movements.
  • the child who is immunosuppressed.

 

 
 

Why register?

Some parts of pmm which involve pictures or videos of children, can only be viewed by registered users. Registering also allows you to bookmark favourite pages and track your viewing.

find out more

pmm for you

Please help us ensure pmm is as useful to you as possible by completing this short survey

complete survey