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Red Flag Conditions

These conditions are potentially life-threatening and include:



Non-accidental injury

NICE Guidance is available to aid clinical assessment and management of red flag conditions which can present with musculoskeletal features. These include; 

Features that suggest severe life threatening conditions:


  • Complete non-weight bearing
  • Pseudo-paralysis of limb
  • Any attempt to passively move the limb is resisted and causes extreme distress
  • Pain severe and non-remitting
  • Limb held in a position which accommodates increased joint volume due to effusion, e.g.hip held in external rotation
  • Night pain and waking
  • Fever
  • Immunocompromised child - due to primary disease or medications
  • Back pain in the unwell child


  • Night pain
  • Pain severe and non-remitting
  • Bone pain
  • Pallor
  • Bruising
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Anaemia, thrombocytopenia
  • Systemic symptoms (lethargy, weight loss, night sweats, fever)
  • Complete non-weight bearing
  • Back pain in the unwell child
  • Weight loss

Non-accidental injury

  • Delay in seeking medical attention
  • History inconsistent with pattern of injury
  • Explanation of injury incongruent with developmental stage of child
  • Repeated presentations
  • Un-witnessed injury
  • Patterns of injury suggestive of non-accidental injury (e.g. bruising over soft tissue areas, multiple bruises, bruises that carry the imprint of an instrument or implement)
  • Distinctive burns e.g. round cigarette burn, forced immersion burn
  • Complete non-weight bearing with occult fracture
  • Type of fracture e.g. metaphyseal
  • Multiple injuries
  • Unkempt appearance and poor hygiene

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