The Limping Child
A limp in a child is a common emergency presentation with a wide differential.
The priority is to rapidly identify limb‑ or life‑threatening causes (septic arthritis, osteomyelitis, slipped upper femoral epiphysis [SUFE], fractures, non‑accidental injury), provide adequate analgesia and immobilisation, and then target investigations and disposition.
Use an age‑aware, structured approach and escalate early when red flags are present (see triage and disposition checklists).
Triage - immediate priorities and “Could this be sepsis?”
- On arrival apply ABC principles and age‑appropriate observations/PEWS and ask “Could this be sepsis?” (NICE NG254).
- Give analgesia promptly and immobilise the limb if fracture or severe pain is suspected; adequate analgesia often makes the clinical examination more reliable.
- Obtain a focused history: onset, preceding illness, mechanism of injury, ability to weight‑bear, fever, night pain, bleeding disorder, sickle cell disease, prior orthopaedic problems, recent antibiotics, and safeguarding concerns.
- If sepsis or septic arthritis is suspected, perform an urgent face‑to‑face assessment, take blood cultures where possible, and start empirical IV antibiotics and fluids per local sepsis pathway without delaying treatment in an unstable child (NICE NG254).
Red flags (urgent senior/orthopaedic review; usually admit)
- Systemically unwell or physiological compromise (tachycardia out of keeping with age, hypotension, poor perfusion, altered conscious level).
- Fever with a hot, swollen joint or severe pain with marked restriction of passive movement...