A limp refers to an asymmetric and abnormal gait. A limp may be due to bone, joint, soft-tissue, neurological, developmental, referred or systemic pathology.
An antalgic gait involves a limp caused by pain in one leg, with the child hurrying through the portion of their gait that involves weight bearing on the affected leg. Acute limp or limb pain may also present with refusal to weight bear.
Causes
The causes of joint pain and limp in childhood can be broadly categorised by age.
Key causes at any age include:
- Fractures
- Infections (e.g., septic arthritis or osteomyelitis)
- Inflammatory disorders (e.g., juvenile idiopathic arthritis)
- Malignancy (e.g., osteosarcoma or leukaemia)
- Non-accidental injury or maltreatment
In children aged 0-3 years, key causes include:
- Toddler’s fracture (undisplaced spiral fracture of the tibia with an intact fibula caused by a twisting injury of the leg)
- Developmental dysplasia of the hip (DDH)
In children aged 3-10 years, key causes include:
- Transient synovitis
- Perthes disease
In children aged 10-16 years, key causes include:
- Slipped upper femoral epiphysis (SUFE)
- Osgood-Schlatter disease
TOM TIP: Examiners like to test your knowledge about the causes of joint pain in a child. It is worth being familiar with the differential diagnosis and distinguishing features of each cause.
Red Flags
Key red flags that may indicate serious underlying pathology include:
- Joint pain in a child under 3 years
- Fever (e.g., septic arthritis or osteomyelitis)
- Unexplained bruising (e.g., leukaemia or maltreatment)
- Bone or joint pain waking the child at night (e.g., osteosarcoma or leukaemia)
- Joint swelling, redness or stiffness (e.g., infection or inflammatory)
- Morning stiffness (e.g., inflammatory)
- Weight loss, fatigue, pallor, night sweats or lymphadenopathy (e.g., infection, inflammatory or malignancy)
- Unable to weight bear (e.g., fracture or infection)
- Severe pain and agitation following trauma (e.g., compartment syndrome)
- Mass on examination (e.g., osteosarcoma)
Last updated June 2026
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