What to Know if Your Child Has a Limp

When you notice your child limping, it can be alarming. Whether it's a sudden refusal to walk or a subtle change in their gait, understanding what to look for and how to communicate with your child's healthcare team is key to getting the right care quickly.

what to look for

Pay attention to these signs and symptoms:

• Sudden refusal to walk or bear weight

• Visible limp or change in gait

• Pain complaints, even if vague (young children may struggle to pinpoint pain)

• Swelling, redness, or warmth in any joints or limbs

• Recent illnesses, fevers, or infections

• Any history of falls, trauma, or injuries

• Fatigue, irritability, or changes in behavior

tips for talking with your care team

When you reach out to your pediatrician, having detailed information helps guide the evaluation:

• Take Videos: A short video of your child walking or trying to walk can be invaluable, especially if the limp comes and goes.

• Photos: If there’s swelling, bruising, or skin changes, take clear photos.

• Jot Down Notes: Record when the limp started, any recent illnesses, fevers, or known injuries, and if the limp changes throughout the day.

• Observe Patterns: Does the limp worsen after activity? Is there morning stiffness? Does it improve with rest?

what we think about

When evaluating a limping child, healthcare providers consider a range of possibilities, from minor injuries to more serious conditions. Here are some common causes:

1. Transient Synovitis (also called ‘toxic synovitis’)

• What It Is: Temporary inflammation of the hip joint, often following a viral illness. It’s the most common cause of hip pain and limping in young children, typically between ages 3 and 8.

• Why It Happens: The body’s immune response to a recent infection can cause inflammation in the hip joint, leading to discomfort and stiffness.

• Timing: Symptoms usually develop 1-3 weeks after a viral illness like a cold, ear infection, or stomach bug.

• Symptoms: Limping, hip or groin pain, sometimes knee or thigh pain (due to referred pain), and reduced range of motion in the hip, often without fever.

• Workup:

  • Physical Exam: To check range of motion, tenderness, and signs of serious infection.

  • Imaging: A hip ultrasound may detect fluid in the joint and rule out more serious conditions.

  • Blood Tests: These help differentiate transient synovitis from more serious infections. Results are usually normal or only slightly elevated.

  • Observation: Most cases improve within 1-2 weeks with rest, ibuprofen, and follow-up to monitor recovery.

2. Toddler's Fracture

• What It Is: A small, subtle fracture of the shin bone, common in young children after a minor fall.

• Symptoms: Refusal to bear weight, limping, minimal swelling.

• Workup: X-rays (sometimes follow-up X-rays are needed if the fracture isn’t immediately visible).

3. Septic Arthritis

• What It Is: A serious infection in a joint that needs immediate medical attention.

• Symptoms: Severe pain, inability to move the joint, high fever, redness, warmth, and swelling over the joint.

• Workup: Urgent blood tests, joint fluid testing, and imaging like ultrasound or MRI.

4. Viral Myositis

• What It Is: Inflammation of the muscles, often following a viral illness such as the flu. It’s particularly common in school-aged children.

• Why It Happens: We don’t know exactly why this happens - there is some thought that specific viruses may attack muscle tissue, or inflammatory markers may affect muscles, or that there is something that predisposes certain children to have this effect.

• Timing: Symptoms typically occur during or shortly after a viral illness, like influenza.

• Symptoms: Muscle pain (especially in the calves), tenderness, difficulty walking, and a stiff-legged gait. It typically happens 24-48 hours after viral symptoms start to improve (toward the end of an illness).

• Workup:

  • Physical Exam: Checking for muscle tenderness, strength, and range of motion.

  • Blood Tests: We may consider blood tests depending on the presentation. Creatine kinase (CK) levels may be elevated, indicating muscle inflammation. Additional tests for liver and kidney markers may also be done. We do typically check a urine test, to make sure that there is no effect on the kidneys (A rare complication of myositis is something called rhabdomyolysis, which causes muscle breakdown and can affect the kidneys and other organs).

  • Observation: Most cases resolve within 3-10 days with rest, fluids, and supportive care.

5. Osteomyelitis

• What It Is: A serious infection of the bone, often caused by bacteria spreading through the bloodstream or from a nearby infection.

• Symptoms: Localized bone pain, swelling, redness, warmth, fever, and reluctance to bear weight or use the affected limb.

• Workup:

  • Physical Exam: Assessing for tenderness, swelling, and signs of systemic illness.

  • Blood Tests: Elevated white blood cell count, ESR, and CRP levels indicating infection.

  • Imaging: X-rays (may be normal early on), MRI for detailed imaging, and sometimes bone scans.

  • Blood Cultures: To identify the bacteria causing the infection.

  • Treatment: Often requires IV antibiotics and sometimes surgical intervention.

6. Other Considerations

• Infections: Bone infections (osteomyelitis), Lyme disease (in certain areas).

• Inflammatory Conditions: Juvenile arthritis.

• Neurological Issues: Weakness, coordination issues.

• Serious Conditions: Rare, but persistent bone pain, night pain, or unexplained symptoms may need further evaluation.

When to Seek Help

• Seek immediate medical attention (ER or call emergency services) if your child has:

  • High fever, severe pain, inability to move a limb, or redness/swelling/warmth of a joint

  • Signs of a serious injury (fall from a height, car accident, etc.)

  • Lethargy, trouble breathing, or signs of severe illness

• Call your pediatrician promptly if your child has:

  • A limp that lasts more than a day without improving

  • Pain without an obvious injury

  • A recent illness followed by new limping

• Monitor at home if your child:

  • Has a mild limp without pain, fever, or trauma, and seems otherwise well

and just remember…

Seeing your child limp can be unsettling, but remember: many causes are minor and resolve with simple care. Trust your instincts—you know your child best. If something feels off, reach out to your healthcare provider. We're here to support you and ensure your child gets the care they need.

Sending you a big hug,

Anjuli

Disclaimer: For educational purposes only and should not be regarded as medical advice or replace the advice of your physician and medical care team.