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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.
  • Child with a chronic disease and Inflammatory Bowel Disease.

Practical tips in performing pGALS:

  • 'Copy me' approach. Stand or sit in front of the child and get them to copy you.
  • Look for verbal and non-verbal clues of discomfort (e.g., facial expression, withdrawal of a limb).
  • 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.

Documentation of pGALS should follow the suggested proforma using the example of a swollen right knee.

 Appearance Movement
Gait               Swollen right knee  Child walks with a limp; the knee is held flexed and the child appears uncomfortable.     
Arms  Normal Normal
Legs Swollen right knee Limited full flexion and extension of the right knee.                        
Spine  Normal.  Normal

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