Limping Child

Is a Limp in a Young Child a Problem that Needs Treatment?

A limping child is a common reason to visit the doctor, and prompt evaluation of a limp is important.  While many causes of a limp will resolve with time, it is important to ensure there is not a more urgent underlying problem that could require urgent treatment.

Limping children, especially young toddlers, can be difficult to diagnose.  Unable to communicate verbally, and often frightened of a medical setting, it is important that they are examined by someone knowledgeable of the causes of a limp.  Listed here are some of the causes of a limp in young children, and the common characteristics that define each of these problems.

Broken Bones

child leg injury
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One of the most common causes of a limp is a broken bone.  Most often, the injury will be noticed, although it's possible that an injury could have occurred with no one witnessing the incident.

Doctors should always be suspicious of child abuse/neglect when stories that don't make sense, there are multiple broken bones, or evidence of multiple healed broken bones.  While doctors understand that fractures often occur in children, it is best to be cautious and ensure the child is not in an unsafe environment.  In addition, there are specific patterns of fractures that almost always occur in an abuse situation.

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Infections are one of the most worrisome causes of limping in young children.  Because of the blood supply to the bones, children are more susceptible to spontaneous joint infections than adults.

Infections within a joint are serious problems, as left untreated, the infection will cause permanent damage to the joint cartilage.  This can lead to early arthritis of the joint. 

Treatment of joint infections usually requires urgent surgery and intravenous antibiotics.  There are a few exceptions, such as Lyme disease, which are typically treated with antibiotics alone.

Infections are usually suspected with a rapid onset of joint pain, often accompanied by a fever.   Tests can be done to detect fluid accumulation in the joint, and often a sample of fluid will be obtained to look for the infection.

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hip pain
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Inflammatory conditions can be difficult to discern from an infection, and often fluid samples from the joint will be obtained before deciding an infection is not the cause of the limp.

The most common type of inflammation is called transient synovitis, a condition that occurs in the hip joint, most commonly in boys.  The symptoms mimic an infection, but spontaneously resolve in about 1-2 weeks, and can be treated with anti-inflammatory medications.  Other causes of a limp include juvenile rheumatoid arthritis.

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Tumors are an uncommon cause of a limp in a child, but like infections,  something not to be overlooked.  Both benign (noncancerous) and malignant (cancerous) tumors can be found in young children.

Symptoms often begin gradually, with pain and a limp often being symptoms that lead to evaluation.  Pain at night (awakening the child from sleep) is sometimes characteristic of tumors.  Imaging tests including x-rays, CT scans, and MRIs can be helpful at determining if there is a tumor, and if a biopsy is necessary.

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Childhood Hip Disorders

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Several childhood hip disorders can lead to a limp.  In very young children, hip dislocations can lead to gait abnormalities, but these conditions are usually addressed before a child begins walking. 

Perthes disease is a condition that occurs when the blood supply to the bone of the ball of the ball-and-socket hip joint is impaired.

Slipped capital femoral epiphysis (SCFE) is a problem in older children (10-14) when the growth plate of the hip slides into an abnormal position.  All of these hip conditions can lead to the development of a limp in a child.

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