CHAPTER 10
The Limping Child: General Approach and Differential Diagnosis
Introduction/Etiology/Epidemiology
• A common pediatric presenting symptom, limping may be secondary to pain, weakness, or musculoskeletal deformity (Table 10-1).
• Growing pains usually do not cause limping.
• The hip is a common source of the presenting problem.
— Toxic (aseptic) synovitis of the hip is a common cause of a limp in children younger than 5 years.
— Note: The limping adolescent with overweight and with knee, thigh, groin, or hip pain has a slipped capital femoral epiphysis until proven otherwise.
• Etiologies range from common to rare and vary by age (Box 10-1).
• Narrow the differential diagnosis by classifying the limp according to
— Gait pattern
— Presence or absence of pain (Figures 10-1 and 10-2)
— Age of the child
— Anatomic region involved
Table 10-1. Common Causes of a Limp
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