Evaluation of Acute and Insidious Gait Disturbance In Children Less Than Five Years of Age

Abstract

In a recent 6-month period, of the 75 children younger than 5 years of age who presented consecutively to the Emergency Room of Cincinnati Children's Hospital Medical Center with either an acute or subacute onset of gait disturbance, a definitive diagnosis was established by the house staff in less than one third of the cases. The relative frequency of accurate diagnosis on an initial encounter in a private practice would be about the same, despite an accurate history, physical examination and selected ancillary laboratory aids. Awareness of the various disease entities discussed in this account and careful attention to the historical keys and variable clinical findings of the various disease states may facilitate an early diagnosis in children with gait disturbance. In selected cases indicated in Table 1, the etiology of the gait disturbance must be urgently determined, whereas in the majority of cases, self-limited conditions are responsible for the alteration and thus, confirmation of a particular disease process is not necessary. It therefore becomes the major responsibility of the physician to identify those children who require hospitalization and active intervention without delay. The physician must also make certain that the undiagnosed children receive frequent and careful follow-up. Parents should be instructed to observe and possibly record their observations of their children for persistence or intensification of symptoms. At follow-up, a repeat history in addition to an interval history may uncover diagnostic possibilities that initially were not considered.2 Repetition of the blood count, cultures, sedimentation rate and roentgenograms at intervals may yield information previously obscured and lead to further diagnostic considerations.