Synopsis
Localise a childhood limp safely, use age and tempo to prioritise diagnoses and identify infection, fracture, SUFE, malignancy and safeguarding concerns before labelling a benign gait disturbance.
- A limp is a presentation, not a diagnosis; first decide whether the child is systemically unwell, unable to bear weight or at immediate structural risk.
- Use age to prioritise without excluding: toddler fracture and infection in young children, Perthes in early school years and SUFE in adolescents.
- Ask the child to point with one finger, but examine the joints above and below, both hips, spine, abdomen, feet and skin because pain is often referred.
Key red flags
Acute complete refusal to bear weight is a red flag at every age and needs an explanation beyond growing pains.
Investigation priorities
Identify fracture, SUFE, Perthes, tumour, deformity and late infection at the clinically localised site.
Management branches
The child is unwell, non-weight-bearing or has severe joint pain, neurovascular change or neurological findings.
- Assess ABCDE, observations and analgesia and stop unsafe walking or provocative testing.
- Obtain urgent paediatric and orthopaedic input, cultures and targeted radiographs, ultrasound or MRI.
The child is stable but the cause and anatomical origin remain uncertain.
Key medicines
Paracetamol during limp assessmentPrescribe the current BNFC age- and weight-based dose, recording exact milligrams, formulation volume, dosing interval and 24-hour maximum.
Ibuprofen for a selected low-risk childUse the current BNFC age- and weight-specific oral regimen for a short course when hydration, kidney function, gastrointestinal risk and NSAID-sensitive asthma history permit.