Limping in children

If the child has a limp the first thing to rule out is an injury. Check from hip to foot for any sprains and strains, bruising or cuts and any objects stuck in the soles of the feet in case they have stepped on a sharp pin, splinter or bit of glass. Check for blisters on the feet or in between the toes. And check that their shoes still fit them.

We’ll talk through possible causes from the doctor’s perspective, but if there’s no obvious cause, this needs a doctor’s examination, so there’s no need for you to do the detective work yourself.

A recent viral infection can sometimes cause an irritable hip (or transient synovitis), where children usually aged 3 to 10 get a sudden pain in the hip, knee or thigh, and this inflammation improves on its own. Young children can get a problem with bone formation called developmental dysplasia of the hip, causing long-term difficulty with movement and pain, and occasionally hip dislocation.

Perthes disease is where the blood supply to the head of the hip bone is cut off, causing pain in the groin, thigh or knee after exercise, and feeling stiff in the hip.

Septic arthritis is a deep-seated infection in the hip joint, usually with an entry point for bacteria to get in, such as a cut or recent operation. Juvenile arthritis can be responsible for painful swollen joints that last longer than 6 weeks.

A broken bone, even if just a hairline fracture and your child doesn’t recall a particular injury, can cause a limp – the pain will not be getting any better, they will have increasing difficulty putting their weight on the leg, and there may be bruising evident.

If you notice their leg turns inward, and they suffer stiffness and pain in the groin, hip or knee, this could be a problem with the top part of the thigh bone called slipped upper femoral epiphysis.

Osgood-Schlatter disease is a condition from overuse of the patellar tendon in older children, causing pain and swelling of the knee joint.

Cancer is rare in children but still a possibility, and a lump on your child’s leg, weight loss and pain at night may point to leukaemia, lymphoma or sarcoma.

If there is no evidence of acute injury and your child is limping this should be treated seriously and your child should see a doctor straight away. If the child is unwell in themselves with fever, vomiting, weight loss or poor appetite or the joint is red, hot, swollen or an inability to put weight on it or move it then the child needs to be examined urgently. You should head to your nearest emergency department for assessment.

It’s cause for concern if there is an unexplained rash or bruising, unexplained lump, persistent infections in the child or pain that wakes the child at night. You may be able to get an urgent appointment at your GP surgery or attend the emergency department.

The doctor will ask questions about the problem and their general health, to point to any particular cause. They will assess how your child is walking, and offer a physical examination of both legs and feet, including the joints. They may also look at the spine.

If an injury has been ruled out, further examinations and tests need to be done to look for other causes. Your doctor will likely refer you to a child specialist called a paediatrician at the hospital, to consider further investigations such as a blood test, X-Rays or further imaging such as an ultrasound, CT or MRI scan.

Pain should be managed with painkillers. To start with simple measures such as paracetamol and ibuprofen can be tried.  For injuries it is advised to ice, elevate and rest the area. Blisters can be treated with blister plasters and by soaking the feet in warm salt water.

If it’s something serious, the doctor can suggest appropriate painkillers and measures to take at home to aid comfort and recovery.