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Limping in a child
Category: Babies & Children · All children symptoms
What it can feel like
A limping child is a child walking with an abnormal gait — favouring one leg, refusing to bear weight, or walking stiffly. The limp is a signpost, not a diagnosis: causes range from a splinter to hip emergencies, and the assessment sorts them by age, fever, pain location (which children localise poorly — hip disease often presents as knee pain), and whether the child can bear weight.
Possible causes
A symptom can have many causes, and most are not serious. The lists below group conditions this symptom can be associated with — common causes first. They are possibilities to discuss with a clinician, not a diagnosis.
Common causes
Limping in a child can be associated with minor trauma (sprains, splinters, a stone in the shoe), transient synovitis (an irritable hip after a viral illness — the commonest cause in young children), muscle strain, and ill-fitting shoes or a verruca.
Other possible causes
Limping can also be associated with septic arthritis (an infected joint — fever, refusal to move the joint, a very unwell child: a surgical emergency), Perthes disease of the hip, a slipped upper femoral epiphysis in older children and teenagers (especially with knee pain and weight gain), fractures including toddler fractures, and rarely bone infection, leukaemia or tumours.
Red flags — when to seek help promptly
- A limping child with fever, or who refuses to bear weight at all — same-day urgent assessment
- A hot, swollen, very painful joint that the child will not move
- Limping after an injury with deformity, severe pain or inability to move the leg
- Limping in a child under 3 years old
- An older child or teenager with hip, groin or knee pain and a limp (possible slipped epiphysis) — keep them off the leg and assess urgently
- Limping persisting beyond a few days, or with weight loss or night pain
What a clinician may do
A clinician will watch the child walk, examine the whole leg chain (foot to spine, with the hip as prime suspect), check temperature, and examine the abdomen and scrotum (both refer pain to the hip region). Blood tests, X-ray and ultrasound of the hip follow the pattern; infected joints go to emergency theatre for washout.
Related guides on MedicalVideos.com
Frequently asked questions
Why does hip disease cause knee pain in children?
The hip and knee share nerve supply (the obturator nerve), so the child's brain reads hip pain as knee pain — a classic trap in which a normal knee X-ray falsely reassures. The rule in paediatrics: knee pain in a limping child means examine and image the hip.
What is transient synovitis?
An inflammation of the hip lining following a viral illness, causing a limp and hip ache for a few days in an otherwise fairly well child. It is the commonest cause of limp in young children — and the dangerous mimic is septic arthritis, which is why fever and inability to bear weight move a limp out of the 'watch' category immediately.
Related symptoms — Babies & Children
Browse the L section of the A–Z list or return to the Symptoms A–Z hub.