My son seems to be limping. Should I call my pediatrician?
Limping can be caused by something as simple as a pebble in her shoe, a blister on her foot, or a pulled muscle. But a limp also can be a sign of more serious trouble, such as a broken bone, infection, or a pulled muscle. For that reason, it’s important to have your pediatrician examine a child with a limp to make sure that no serious problems exist.
Some children limp when they first learn how to walk. Early limping can be caused by neurological damage. But any limp around the time your child begins to walk needs to be investigated as soon as possible, since the longer it goes untreated, the more difficult it may be to correct. Once walking is well established, significant sudden limping usually indicates one of several conditions:
A “toddler” fracture
Hip injury or inflammation (synovitis)
Previously undiagnosed developmental dysplasia (abnormal development) of the hip (DDH)
Infection in the bone or joint
Kohler’s disease (loss of blood supply to a bone in the foot)
Juvenile idiopathic arthritis
A "toddler" fracture is a spiral fracture of the tibia (one of the leg bones that extends from the knee to the ankle). It can occur with minor accidents such as when children trip, jump, or fall, or when they go down a slide in a n older child's or adult's lap with their feet tucked under them. Sometimes children can explain how the injury occurred, but usually they have difficulty recalling exactly what happened. At times an older sibling or child care provider can solve the mystery.
Hip problems that cause a limp at this age usually are due to a viral joint infection and need to be brought to the attention of your pediatrician. When a child has an infection in the bone or joint, she usually experiences a fever, swelling of the joint, and redness. If the infection is in the hip joint, the child will hold her leg flexed or bent at the hip and be extremely irritable and unwilling to move the hip and leg in any direction, although swelling and redness may not be obvious in this deep joint.
Sometimes a child is born with a dislocated hip (DDH, developmental dysplasia of the hip) that that may not be noticed until she starts to walk. As one limb is shorter and less stable than the other, she will walk with an obvious limp.
Limping is a major reason that parents of children with juvenile idiopathic arthritis seek medical care. In a typical case, a child will not complain of being in pain. But she limps nevertheless, with this limping at its worst after waking in the morning or from a nap, and becoming less noticeable with activity.
With minor injuries, such as a blister, cut, or sprain, simple first-aid treatment can be performed at home. However, if your child has just started walking and is constantly limping, your pediatrician should evaluate her. It is all right to wait twenty-four hours if your older child develops a limp since sometimes the problem will disappear overnight. But if your child is still limping the next day, or is in extreme pain, see your pediatrician.
X-rays of the hip or the entire leg may be necessary to make the diagnosis. If there is an infection, antibiotics should be started and hospitalization may be required. Intravenous (IV) antibiotics may be given in high doses to allow them to get to the joint and bone. If a bone is broken or dislocated, the limb will be placed in a splint or cast and the child will be referred to an orthopedist for evaluation and further management. It is also advisable to see a pediatric orthopedist if a congenital dislocated hip (DDH) is diagnosed.