Limping

One of the most taught and practiced workups for pediatric doctors is the evaluation of “The Limping Child.” Kids limp for various reasons, most are minor, while some require immediate intervention. What puts a wrench into the whole thing is that the limping child is often too young to talk that much, let us know exactly what happened before they started limping, and what part of the leg or hip is painful or not painful. So as a pediatrician, we are going to ask a bazillion questions to try to figure out what is going on. If the limp improves over a few hours, the child is distractable, and they can bear weight on that leg/foot/hip, then we just monitor the kiddo with Tylenol/acetaminophen or Advil/Motrin/ibuprofen to help with some inflammation from the probable unwitnessed minor injury that caused the leg to be sore.

But if we have a kiddo who cannot bear weight on the affected side/leg and is having a fever with leg or joint pain, then further investigation is warranted. Sometimes this is a simple X-ray to look for possible fracture or bone injury. Other times it may require a more complex X-ray where we put the legs and hips in different positions to see if everything is aligned well, including where the femur interacts with the hip bone.

If the kiddo has or recently had a viral cold or cough and is now complaining of a painful joint or is limping, we will investigate a possible infectious cause called transient or reactive synovitis, when a joint can become inflamed due to a viral infection. Kids and adults can even get bacterial joint infections, often presenting with a fever and an extremely painful joint. The kiddo will look rather ill due to the amount of bacteria just hanging out where it should not be. If there are bacteria in the joint space, as you can imagine, that is not good and would get immediate attention from our orthopedic (bone specialist)friends to drain and clean the joint space.