6 Causes Of Child Limping: Symptoms, Diagnosis And Treatment

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Pediatric limping is most often caused by physical injuries. However, prolonged limping without a physical injury may be a cause for concern. The causes of a child 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 cause 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

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 whyyour childis limping.

Causes Of Limping In Children

Limping causes 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 acommon causeof 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 kids. One such infection is septic arthritis. The symptoms of septic arthritis are similar to that of irritable hips, 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 andknee jointsbut 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 havea 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, theautoimmune diseaseis 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).

一项研究评估的发病年龄的青少年艺术hritis in 1081 children. The graph below depicts the results of the study. According to the findings, arthritis incidence was highest in girls aged one and four years. However, during adolescence, there was an even distribution between the genders. The onset of childhood arthritis occurs most commonly between ages one and four. However, there is a lower incidence in the first year of life and a less pronounced gender bias in adolescence.

Juvenile idiopathic arthritis epidemiology by age and gender

Source:Biological classification of childhood arthritis: roadmap to a molecular nomenclature; Nature Reviews Rheumatology

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.

• CongenitalⁱXA condition or trait present at birth and present from the beginning of one's life and is often inherited genetically.disabilities of the hip, such asdislocateddysplasiaⁱXAn unusual presence of abnormal cells in an organ or tissues.of the hip. These can occur before birth or develop later.

• Cerebral palsyⁱXA neurological disorder affecting a person's muscle control, thus affecting posture and balance.. It is a condition that affects the nerves, causing the child to limp(2).

• 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 in limping diagnosis and determine if there is a fracture or a sprain in the legs that might be causing the limping.

Two tests helping in limping evaluation, 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, andPerthes diseaseⁱXA rare childhood disorder causing a loss of blood supply to the hip joint, leading to weak bones and increased chances of fractures..

2. 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 orosteochondritisⁱXA condition that arises from reduced blood flow, leading to the separation of a bone fragment from the surrounding region..

Treatment For Limping In Children

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, limping treatment may involve 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 regularstretching exercisesbefore playing. You can also give them a nutritious diet so that their bones grow strong and healthy.

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