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Practical tips and pGALS

When to perform pGALS:

Unwell child with Pyrexia.
Child with limp.
Delay or regression of motor milestones.
The ‘clumsy’ child in the absence of Neurological Disease.
Child with chronic disease and known association with musculoskeletal presentations (such as with Inflammatory Bowel Disease).

Practical tips in performing pGALS:

'Copy me' approach
Look for verbal and non-verbal clues of discomfort (e.g. facial expression, withdrawal).
Do the full assessment as extent of joint involvement may not be obvious from the history.
Look for asymmetry (e.g. muscle bulk, joint swelling, range of joint movement).
Consider clinical patterns (e.g. non-benign hypermobility and Marfanoid habitus or skin elasticity) and association of leg length discrepancy and scoliosis.