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

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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

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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 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 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 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).

Quick fact

Lyme disease may affect the joints and cause limping in children. It may happen if your child has been in an area with many ticks (13).

4. Juvenile arthritis

This is a condition found in children under 16 years. According to the American College of Rheumatology, juvenile arthritis affects about one in every 1000 children. It is commonly characterized by the swelling of the joints and lymph nodes for up to six weeks. Although the exact causes are not known, autoimmune diseases in children are 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).

A study evaluated the age of onset of juvenile arthritis 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

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 cases, the pain might radiate to the thigh and knee and cause knee pain in children (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.

• CongenitalⁱA 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 as dislocated dysplasiaⁱAn unusual presence of abnormal cells in an organ or tissues. of the hip. These can occur before birth or develop later.

Discussing her daughter Marina’s diagnosis of developmental dysplasia of the hip (DDH), Débora M. H, a blogger and mom, says, “For me, my daughter was normal. I almost didn’t notice that she was limping. Marina started walking at one year, four months; two months later, a friend asked me about her hip: ‘something is wrong, you should see a doctor,’ she said.’ I took her to the doctor to make others sure she was healthy. ‘She has a problem with her hip and will need surgery,’ the doctor told me. “Fortunately, nothing went wrong: she used the body cast (from her hip until her feet) for one and a half months, then used braces along her legs for three months (at the end, just for sleep), made some sessions of physiotherapy and, now, the only medical prescription is to play a lot (i).”

• Cerebral palsyⁱA 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).

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

Things to know

A herniated spinal disc may cause pain, numbness, tingling, or weakness in one or both legs (14). It has become more common in children and may cause limping.

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, and Perthes diseaseⁱA 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 or osteochondritisⁱA condition that arises from reduced blood flow, leading to the separation of a bone fragment from the surrounding region. .

Treatment For Limping In Children

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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, 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 regular stretching exercises before playing. You can also give them a nutritious diet so that their bones grow strong and healthy. In addition to conventional treatments, some parents also go for complementary therapies such as chiropractic care or acupuncture, which may help alleviate symptoms. However, it’s important to consult with a healthcare professional before starting any alternative treatments.

Things to know

Physical therapy, such as pelvic traction, gentle massage, and stretching exercises may be recommended by the doctor in some cases (14)..

Infographic: Reasons A Child Might Be Limping

If you have observed your child limping, there can be an underlying problem that may require prompt medical attention. Knowing the cause early can help manage and treat it effectively. The infographic below highlights the various reasons a child may limp.

Illustration: Momjunction Design Team

Illustration: Causes Of Child Limping: Symptoms Diagnosis And Treatment

Image: Dall·E/MomJunction Design Team

This video gives an in-depth explanation regarding limping. Watch the video to gain some insights into the different types of limping.

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Reviewer Author Editor Fact Checker

Dr. Dur Afshar AghaMS

Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years 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.

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Dr Bisny T. JosephMedical Doctor

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 around 5 years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert.

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Dr. Ritika ShahBDS, CLC

Dr. Ritika Shah is a certified lactation counsellor (CLC) from iNational Health Care Academy, Singapore and a dental surgeon with more than seven years of clinical experience across various cities in India. She did her graduation in Dentistry from KM Shah Dental College.

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Shinta Liz SunnyM.Tech

Shinta is a biotechnologist who is highly intrigued by science and technology. She holds a master's degree in Biotechnology from Karunya Institute of Technology and Sciences and a PG Diploma in cellular and molecular diagnostics from Manipal University.

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