Red Flags

Clinical Features that suggest severe life threatening conditions:

Sepsis:

• Complete non-weight bearing.
• Pseudo-paralysis of limb.
• Any attempt to passively move the limb is resisted and causes extreme distress.
• Severe and non-remitting pain.
• Limb held in a position which accommodates increased joint volume due to effusion ; e.g., a flexed knee with a mild effusion.
• Night pain and waking.
• Fever.
• Immunocompromised child - due to primary disease or medications.
• Back pain in the unwell child.
• If cultures are negative, consider rheumatic fever in endemic areas (e.g. school aged children from Maori, Pacific Islands, India or Asia).

Malignancy:

• Night pain.
• Severe and non-remitting pain.
• Bone pain.
• Pallor.
• Bruising.
• Lymphadenopathy.
• Hepatosplenomegaly.
• Anaemia, thrombocytopenia.
• Systemic symptoms (lethargy, weight loss, night sweats, fever).
• Complete non-weight bearing.
• Back pain in the unwell child.
• Weight loss.

Non-accidental injury:

• Delay in seeking medical attention.
• History inconsistent with pattern of injury.
• Explanation of injury incongruent with developmental stage of child.
• Repeated presentations.
• Unwitnessed injury.
• Patterns of injury suggestive of non-accidental injury (e.g., bruising over soft tissue areas, multiple bruises, bruises that carry the imprint of an implement or instrument)
• Distinctive burns e.g. round cigarette burn, forced immersion burn
• Complete non-weight bearing with occult fracture
• Type of fracture (e.g., metaphyseal fracture, posterior rib fractures, skull fracture, any type of fracture in a non-ambulant child).
• Multiple injuries.
• Unkempt appearance and poor hygiene.

Further information is available

NICE guidance regarding non-accidental injury

NICE Guidance on suspecting cancer in children 

NICE guidance on fever in young children 

 Further information about limp is available. 

https://www.rch.org.au/clinicalguide/guideline_index/Child_with_limp/