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 CPK 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.
Some parts of pmm India 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.
Please help us ensure pmm is as useful to you as possible by completing this short survey