Joint pain and limping in children

A child who limps is a presentation orthopaedic surgeons take seriously, because the range of causes runs from entirely harmless to genuinely urgent, and children describe pain poorly.

Take a child to hospital the same day if

• The child has a fever together with a painful joint, or looks unwell.
• The child refuses to bear any weight at all.
• There is significant swelling, redness or heat over a joint.
• Infection in a joint is uncommon but time critical, which is why a limping, feverish child is never left overnight.

Common and usually less serious

• Irritable hip following a viral illness, common in younger children and self-limiting.
• Minor injury the child has not mentioned, which is extremely common.
• Growing pains, which are typically at night, in both legs, and gone by morning. Pain in one leg, or pain that limits activity, is not growing pains.

Needs proper assessment, though not the same hour

• A limp lasting more than a few days.
• Pain in a specific spot that is reproducible.
• Knee pain in an older child or adolescent, which can come from the hip and is a well-known pitfall.
• Any persistent change in the way a child walks.

What an assessment involves

• Examination of both legs, including the hip even when the child points at the knee, usually X-rays, and blood tests if infection is a possibility.