Understand | diagnose | change

Whether you are looking to learn more about paediatric musculoskeletal problems, or are involved in the care of children, then PMM and PMM-Nursing will help you change your clinical practice for the better.


 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.