Alexander K.C. Leung, MBBS, FRCPC, FRCP (UK & Irel), FRCPCH; Jean François Lemay, MD, FRCPC


J Pediatr Health Care. 2004;18(5) 

In This Article

Abstract and Introduction


A child who limps often presents a diagnostic challenge. The differential diagnosis is extensive. Although the most common cause is trauma, awareness of other potential causes is important. The age of the child and the pattern of the gait help narrow the differential diagnosis. In most cases, a diagnosis can be made from the history and physical examination. If the diagnosis is not obvious after a careful clinical evaluation, plain radiographs provide an excellent means of screening for fracture, joint effusion, lytic lesions, periosteal reaction, and avascular necrosis. Other tests should only be ordered when indicated.


A limp is defined as any deviation from a normal gait pattern for the child's age. Physicians must take any limp seriously; children complain of pain frequently, but they limp almost always in the context of true organicity (Mankin & Griswold, 2001). The causes of limping are numerous, ranging from trivial to life-threatening conditions. The limping child is often a diagnostic enigma. The challenge is to make an appropriate diagnosis in a timely fashion without exposing the child to unnecessary diagnostic studies.


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