Basildon EM Handbook 2018

Limping Child

March 2018 | by EMauthor

Try to establish which part of the lower limb is affected, e.g. hip, knee etc, remembering that in significant number of cases hip problems can present with knee pain.  Assess carefully and exclude serious conditions. The important differential diagnoses of hip pain are;

•Trauma, in all ages

•Irritable hip or transient synovitis, in the younger children (peak incidence 3 – 6 years)

•Perthes disease or osteochondritis of the hip in older children (peak incidence 4 – 9 years)

•Slipped upper femoral epiphysis, in early teens (peak incidence 12 – 15 years)

The assessment should include general examination of the child with recording of temperature and other vital signs

•Any child with a limp who is running a temperature or is systemically unwell should be referred urgently to orthopaedics

•All children with a limp should have an x-ray of the affected joint or part of the lower limp that is involved, in cases of hip pain both hips should be x-rayed preferably in frogs leg position

•If no trauma is involved children should have blood tests namely FBC, ESR and CRP. Discuss with consultant as to whether this assessment is carried out by EM or orthopaedics. A blood culture should be taken in all children who are pyrexial or systemically unwell

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