The limping child - when to worry and when to refer: a GP's guide.

Abstract

A paper by the King’s Fund in 2010 identified that GPs were more likely to refer younger children than older children with equivalent needs, suggesting lower confidence levels and lower thresholds for referrals.1 An estimated 30% of GP consultations are musculoskeletal2 and a quarter of all patients who visit their GP each year are aged <18 years.3 It is, therefore, important that GPs have a comprehensive understanding of common paediatric orthopaedic pathologies. A limp is a common reason for a child to present to the GP. It is also one of the commonest referrals to the on-call orthopaedic team, due to the long list of differential diagnoses, some of which require urgent treatment. This article outlines an approach to assessing a child with a painful limp and indications for referral to specialist services. There are many causes for a limp in a child; many are age specific (Box 1). | All ages | |:---------------------------:| ------------- | | Fracture/soft-tissue injury | Cellulitis | | Non-accidental injury (NAI) | Neoplasm | | Septic arthritis | Neuromuscular | | Osteomyelitis | | | Age 1–3 years | Age 4–10 years | Age 11–16 years | |:--------------------------------------------------------------------:| ----------------------------------- | ---------------------------------------------------------------------------------------------------------------------- | | Septic hipDevelopmental dysplasia of the hip (DDH)Toddler’s fracture | Perthes’ diseaseTransient synovitis | Slipped capital femoral epiphysis (SCFE)Juvenile rheumatoid arthritisOsteochondritis dissecansOsgood–Schlatter disease | Box 1. Common conditions to consider when assessing a limping child, with age relevance It is important to take a detailed history from the patient, if possible, and parents. A key starting point is establishing whether the limp is secondary to trauma or atraumatic. Non-accidental injury (NAI) should always be …