When to Refer

Indications for urgent (same day) assessment of limp (acute day unit / general paediatrics / paediatric rheumatology / orthopaedics) - depending on your local referral pathways;

• The very young child (under 3 years of age).
• The ill and febrile child.
• The non-weight bearing child.
• The child with painful restricted hip movements.
• The child who is immunosuppressed.

A recommended clinical guideline for limp is available. X ref to RCH guidlines 

Assessment will include history and examination, blood tests and imaging. These are covered in more detail under the red flag and key conditions.  

It is important to consider general assessment and joints other than excluding hip pathology. 

The child with a limp must have a follow up plan,  parents should have instructions when to seek medical attention (i.e. 'safety netting') and further assessment is needed for the child who is not recovering, or is intermittently limping.

Before embarking on a series of investigations, especially if these may be invasive or incur delay, then consider referral to paediatric rheumatology. Many children with inflammatory joint or muscle disease have a history of intermittent limp without a clear diagnosis (see Pitfalls) and may have had investigations such as MRI or synovial biopsy that is not warranted. 

Guidelines for a suggested approach to atraumatic limping child is available.