Limping child

  • Initial pre-referral workup

    Clinical history

    Common causes not to be missed:

    All ages

    • trauma
    • infection – septic arthritis, osteomyelitis
    • tumour
    • referred pain

    One to four years

    • developmental dysplasia of the hip
    • irritable hip (transient synovitis)

    Four to 10 years

    • Perthes disease
    • irritable hip (transient synovitis)
    • juvenile idiopathic arthritis

    10 to 16 years

    • slipped upper femoral epiphysis


    Depending on clinical presentation, consider:

    • FBE, ESR,CRP
    • hip X-rays (AP and lateral)
    • hip ultrasound

    GP management

    Refer parents to Limping Child (fact sheet).

    Indications for specialist referral


    • red flag signs – unwell, flushed, lethargic, fever, flat, anorexic
    • joint is irritable and stiff
    • not improving