A septic hip in a child requires emergent drainage. It should be distinguished from other pathologic hip conditions in a child by history, physical exam, a hip ultrasound, and laboratory data (1). Recent publications support an algorithmic approach to the evaluation of a limping child to accurately distinguish a child with a septic hip from a child with toxic or transient synovitis. Kocher noted four risk factors—refusal to walk, fever, elevated white blood cell count (greater than 12,000 mm3), and erythrocyte sedimentation rate (ESR) above 40 mm/h—and validated these risk factors in a subsequent report (2). However, other centers have found that these four factors may not have as high a predictive value in determining a septic hip as was originally thought (3). The finding of a C-reactive protein (CRP) level above 1.0 is highly suggestive of infection as well (4).