a popular one

Red flags

Age <3y
Unable to weight bear
Systemically ill, fever → septic arthritis?
9y with pain/restricted movement
Normal motor milestones

Ddx

at any age

constant, localising, reproducible pain:
- infection - osteomyelitis, septic arthritis
- trauma (bony vs soft tissue injury) - pelvis MSK injuries in children
malignancy
metabolic disease
rash/bruising → inflammatory joint disease, non-accidental injury
muscle weakness → neuromuscular disease e.g. spina bifida

by age

Age	Ddx
< 3y	Toddler's fracture developmental dysplasia of the hip
3-10y	Transient synovitis Perthé's disease
10-18y	Slipped upper femoral epiphysis Perthé's disease Osteochondritis dissecans Osgood-Schlatter disease Chondromalacia patellae

misc:

sever's disease = heel pain, most often in boys age 10-12

investigations

Local limping child pathway says get X-rays and bloods on everyone
Pelvic XR should have AP and frog-leg view. GOOD LUCK GETTING IT >:(

#incomplete #paeds

sources/links

https://dontforgetthebubbles.com/the-child-with-a-limp/
https://www.rcemlearning.co.uk/modules/the-limping-teenager/
https://www.rcemlearning.co.uk/foamed/the-limping-child/ → see guidelines
https://dontforgetthebubbles.com/osteochondrosis/
https://dontforgetthebubbles.com/the-child-with-a-limp/
https://pemplaybook.org/podcast/please-just-stop-limping/
https://cks.nice.org.uk/topics/acute-childhood-limp/diagnosis/assessment/
https://bestpractice.bmj.com/topics/en-gb/709
https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/Paediatrics/Orthopaedic/AcuteAtraumaticLimpInChildrenClinicalGuideline.pdf