6 Causes Of Child Limping: Symptoms, Diagnosis And Treatment

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Limping in children is most often caused by physical injuries. However, prolonged limping without a physical injury may be a cause for concern. The causes of limping could range from a minor injury to an underlying medical condition. If limping in children is associated with pain, it should not be dismissed as growing pain since such pains never causes limping.

Ice application, rest, or physical therapy can help manage limping caused by a physical injury. However, consult your child’s pediatrician if your child starts limping for no apparent reason.

Read this post to know more about the causes, symptoms, diagnosis, and treatment of limping in children.

Symptoms Of Limping In A Child

Pain in the back of the legs.

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While limping itself is a symptom of an injury or medical condition, it could be difficult to determine it in young children. Here are some symptoms that can accompany the limping.

  • Weakness or numbness in the legs or feet
  • Pain in the hips
  • Frequent falls
  • Inability to sit for too long
  • Complaints of pain in the back of the legs
  • Inability to move the toes
  • A lack of balance while walking

Once you have identified the symptoms, next, you need to understand why your child is limping. 

Causes Of Limping In Children

Physical injury is a common cause of limping in children.

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The causes of limping in children may range from a simple physical injury to an underlying medical condition. Let us look at each one in detail.

1. Physical injury

This is a common cause of limping in children. If your child experienced physical trauma while playing and has started to limp, it could be due to gait deviations or a fracture or sprain in the hips, ankle, or legs. Your doctor will likely ask you the following questions to confirm if the limping is due to a fracture (1).

  • Did the child get up immediately after falling?
  • When did the limping start?
  • Does your child feel comfortable while crawling?
  • Did you see any external injuries?

2. Irritable hip

Also known as transient synovitis, irritable hip is a common condition that causes hip pain and limping in children. It generally occurs due to the inflammation of the lining that covers the hip joint. The symptoms include pain and limited motion of the hip, and the condition is self-limiting (2).

3. Infections

Infections of the bone can also cause limping in children. One such infection is septic arthritis. The symptoms of septic arthritis are similar to that of irritable hip, so these two are often confused. Septic arthritis is characterized by a bacterial infection of the synovial joint and joint tissues. It mostly affects the hip and knee joints but could also affect the shoulder and ankle joints. Studies suggest that septic arthritis is mainly seen in children under the age of four.

Along with the limping, a child with septic arthritis would also have a fever, joint pain, joint swelling, reluctance to walk on the affected limb, warmth around the affected joint, loss of appetite, and episodes of vomiting (3). Another type of bone infection caused by bacteria is osteomyelitis, which is characterized by inflammation of bone. The condition can also cause limping in children (4).

4. Juvenile arthritis

This is a condition found in children under 16 years. It is commonly characterized by the swelling of the joints and lymph nodes for up to six weeks. Although the exact cause is not known, the autoimmune disease is believed to be triggered by a combination of genetic factors, environmental factors, and a weak immune system.

Juvenile arthritis is also characterized by limping, especially in the morning, high fever, skin rash, and clumsiness (5).

5. Legg-Calve-Perthes

Legg-Calve-Perthes (LCP) is a rare condition found in children aged five to seven years. It is characterized by painful limping and limited range of motion of the hip. It affects the femoral head, and the pain is often felt during physical activity. In some children, the pain might radiate into the thigh and knee (6).

LCP occurs when the blood supply to the femoral head is temporarily disrupted. The revascularization(restoration of blood flow) may occur over two to four years if the child is under 12 years old at the onset of the disease (7).

6. Slipped capital femoral epiphysis (SCFE)

This is a condition that affects the hips of a child. In SCFE, the thigh bone ball slips off the thigh bone’s neck. Children might get this condition after a sudden fall or an injury.

It is characterized by limping, pain that gets worse with activity, pain in the thigh, knee, and groins, and an outward-turned leg when they walk (8).

Other medical conditions that can result in limping are:

  • Scoliosis, which is characterized by an abnormal curvature of the spine. This may cause the body to lean to one side, causing the child to limp.
  • Congenital disabilities of the hip, such as dislocated dysplasia of the hip. These can occur before birth or develop later.
  • Cerebral palsy. It is a condition that affects the nerves, causing the child to limp (2).
Cerebral palsy may cause limp in children.

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  • Acute leukemia. In rare cases, this could also be responsible for lower-limb pain and limping (9).

Diagnosis Of Limping

Based on the additional symptoms, your doctor might order the following tests to understand the reason behind the limping.

Physical examination, X-rays, and ultrasounds may help determine if there is a fracture or a sprain in the legs that might be causing the limping.

Two helpful tests that might help your doctor determine the cause behind the limping include (1)

  1. Simulated prone internal rotation of the hip. In this test, the child is held chest-to-chest by the parent, and the hips are extended fully. This position gives an accurate measure of the hip’s internal rotation and can help determine synovitis, arthritis, and Perthes disease.
  1. Crawl test. If the child is limping but can crawl, the problem is limited to the leg and feet. Thus, pelvis osteomyelitis and hip and knee sepsis can be ruled out. However, if they find trouble crawling, it could likely be fracture of tibia foot or osteochondritis.

Treatment For Limping In Children

You can also give them a nutritious diet so that their bones grow strong and healthy.

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Your doctor is the best person to evaluate the condition and suggest the best course of action.

If it is a minor injury or an ankle sprain, the doctor might suggest restricting the movement, cold compresses, and elevating the injured leg. In the case of slipped upper femoral epiphysis, the child may need surgery as soon as possible. Your doctor may prescribe crutches to reduce the weight on the injured leg.

Your doctor may also prescribe antibiotics for the treatment of infection. You can prevent certain causes such as injury and sprains by instructing your child to do regular stretching exercises before playing. You can also give them a nutritious diet so that their bones grow strong and healthy.

Frequently Asked Questions

1. When should I worry about my child limping?

Limping in children is generally due to minor injuries and is not a cause for worry. However, you should see a doctor if your children (10)

  • Experience sudden pain in their hip, thigh, or knee
  • Cannot lift their weight on their legs
  • Observe a change in the shape of their legs
  • Experience severe pain in the lower abdomen
  • Feel unwell, hot, and shivery
  • Notice worsening of their symptoms.

2. What should I do if my child is limping?

If your child is limping for minor reasons such as a splinter or blister, administer first aid treatment. You may also apply warm or cold compresses for 10 to 20 min. If your child complains of pain, give them a pain killer such as ibuprofen or acetaminophen.

However, if the pain continues along with fever, redness, and swelling, contact a doctor to know the possible cause (11).

3. Can a viral infection cause a child to limp?

Toxic synovitis or transient synovitis is one of the causes of limp and hip pain during early childhood. The exact cause of this condition is unknown, but it develops after a viral infection (12). Fortunately, toxic synovitis resolves on its own. Doctors may prescribe a nonsteroidal anti-inflammatory medication for relief (13).

Limping in children could be due to a minor physical injury, inflammation of the hip joints, or other infections. Minor injuries are common among children since they are physically active. If the limping is due to a minor sprain or fracture, the treatment usually includes rest and cold compresses to reduce the pain. But the prognosis of limb pain due to other conditions might depend on the extent of the infection. If you notice your child limping frequently or if the limping is accompanied by other symptoms, such as the inability to sit for long, hip aches, or inability to walk, consult your doctor.

Key Pointers

  • Limping in children may be caused by an external injury, nerve problems, bone infections, arthritis, or other underlying issues.
  • Numbness, hip pain, frequent falls, and other symptoms may accompany limping.
  • Doctors may suggest cold compress, movement restriction, or physiotherapy for sprain and injury-related limping.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
  1. Jessica Burns and Scott Mubarak; Evaluation of the Limping Child; Rady Children’s Hospital.
    https://www.jposna.org/ojs/index.php/jposna/article/download/109/87/
  2. Limping In Children; National Health Service (UK)
    https://www.nhs.uk/conditions/limp-in-children/
  3. Septic Arthritis; St. Louis Children’s Hospital
    https://www.stlouischildrens.org/conditions-treatments/septic-arthritis
  4. Sindhur P.K et al.; Study of Osteomyelitis in pediatric patient; J PediatrRes (2017).
    https://pediatrics.medresearch.in/index.php/ijpr/article/view/259/516
  5. Juvenile Arthritis; Symptoms & Causes; Boston Children’s Hospital
    https://www.childrenshospital.org/conditions-and-treatments/conditions/j/juvenile-arthritis/symptoms-and-causes
  6. Vito Pavone et al.; Aetiology of Legg-Calvé-Perthes disease: A systematic review; World Journal of Orthopedics (2019).
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429000/
  7. Benjamin Joseph; Management of Perthes’ disease; Indian Journal of Orthopaedics (2015).
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4292319/
  8. Slipped Capital Femoral Epiphysis in Children; University of Rochester Medical Center
    https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02782#:~:text=Slipped%20capital%20femoral%20epiphysis%20(SCFE
  9. Y.Lefevre et al.; Pediatric leukemia revealed by a limping episode: A report of four cases; Orthopaedics & Traumatology: Surgery and Research (2009).
    https://www.sciencedirect.com/science/article/pii/S1877056808000078
  10. Limping in children.
    https://www.nhs.uk/conditions/limp-in-children/
  11. When Your Child Limps.
    https://www.stlouischildrens.org/health-resources/pulse/when-your-child-limps
  12. Toxic Synovitis.
    https://kidshealth.org/en/parents/toxic-synovitis.html
  13. What Causes a Child to Limp?
    https://www.hss.edu/pediatrics-causes-child-to-limp.asp
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Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made...
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Dr. Dur Afshar Agha

(MS)
Dr. Dur Afshar Agha is a consultant pediatrician with decades of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association. She has also completed her Post Graduate Program...
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