Limp is a symptom and not a diagnosis.

• Red flag features include high fever, weight loss, night pain and lethargy. Infection and malignancy must be excluded.
• A limp persisting beyond two weeks requires referral to paediatrics, paediatric rheumatology or paediatric orthopaedics (pending local referral pathways).
• Morning stiffness (even if no obvious joint swelling) suggests inflammatory causes such as Juvenile Idiopathic Arthritis. Regression of motor milestones may be apparent.
• Many hip pathologies cause limp, but remember to assess other joints and think of extra-articular causes (including footwear and soles of feet for minor trauma or infection).
• Trauma including non-accidental injury, must be considered but it is noteworthy that children with pathology may be more prone to falling. 
• Assessment will include history and examination, blood tests and imaging. 
• It is important to examine all joints and not just the legs. pGALS is a useful and quick tool to assess all joints and guide further detailed examination. 
• Motor milestones are important - if motor development is delayed consider a CK test early.
• It is important that a child with a limp has a follow up plan and parents have instructions for when to seek health care advice.

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