What Causes a Child to Limp?

It can be disconcerting to see a child limp, and it can happen for many different reasons. However, it often takes some detective work to determine the cause, especially in toddlers.

“What might cause a limp in a young child is often very different from what causes a limp in a teenager,” explains Dr. Karen Onel, chief of Pediatric Rheumatology at Hospital for Special Surgery. “In older kids, the reason is generally more obvious.”

Limping in Older Children and Teens

Older kids can usually give you a pretty good sense of why they’re limping, according to Dr. Onel. “They can tell you where the pain is coming from,” she says. “If a healthy, active pre-teen or teenager suddenly starts to limp, the first thing we think about is whether they sustained an injury while being physically active.”

In these cases, they should be encouraged to rest the injured limb. If the pain and the limp don’t get better over the next few days, it’s advisable to see a doctor, according to Dr. Onel. Signs that a more serious problem is causing the limp include fever, persistent swelling, numbness, and the inability to move or put pressure on the painful limb. These symptoms should be checked out sooner rather than later.

Limping in Young Children

When a small child or toddler limps, it can be more difficult to get to the bottom of it. “We can’t always tell exactly where it’s coming from. It could be from a problem with the back, hip, knee, foot or ankle. Often small children can’t verbalize where they feel pain,” Dr. Onel explains. “In fact, children aged two and under may not be able to specifically express that they’re in pain. Limping is the tip-off that something is wrong. “

Dr. Onel says limping is not uncommon and is usually not cause for alarm. A myriad of conditions can cause a limp, and some are much more serious than others. It can arise from a minor injury; a more serious injury such as a fracture; a structural abnormality; a developmental issue; inflammation in a joint; or an infection in a bone or joint. 

“A persistent limp is never normal,” Dr. Onel says. “Although it is often not the result of a serious condition, any child who is persistently limping for more than 48 hours should be evaluated by a doctor.”

Diagnosing the Cause of a Limp

To determine the cause, the physician will take a detailed medical history, ask about the child’s recent activities, and may order an X-ray and/or blood tests. To make the diagnosis, the doctor will seek answers to the following questions:

• Has the child sustained a recent injury? Children run around and fall all the time. However, it isn’t always apparent that they’ve had an injury that requires medical attention.
• Is the child limping only in the morning, and is it better when they start moving around? A morning limp could be a sign of joint stiffness and juvenile arthritis, especially if there is also swelling in a joint.
• Is the limp only present or worse after activity? This could be a sign of an overuse injury in an athletic child.
• Has the child been immunized recently? Sometimes a muscle injection can cause a temporary limp.
• Has the child traveled or been in an area where there are a lot of tics? The physician may order a test for Lyme disease, which could affect the joints.
• Does the child have fever? This could be a sign of an infection.
• Has the child or anyone else in the family been ill recently? Children can have joint inflammation after an illness.

The Most Common Cause of a Limp in Children

A common reason for pain and limping in early childhood is a condition called “transient synovitis,” also known as “toxic synovitis,” which is temporary, according to Dr. Onel. It’s an inflammation of the fluid in the hip joint. Although the cause is unknown, it often arises after a child has a cold or another type of virus.

In addition to limping, symptoms can include a low-grade fever up to 101°F; hip discomfort or a refusal to walk; and sometimes pain that radiates to the thigh or knee. “A limping child who has fever and displays signs of fussiness or a lack of desire to play should be evaluated as soon as possible,” Dr. Onel advises.

Transient synovitis usually goes away in a week or two and does not cause any residual problems. When a child is diagnosed with the condition, doctors prescribe rest and nonsteroidal anti-inflammatory medication for symptom relief.

When a Limp Requires Urgent Attention

An infection in a bone or joint can also cause a limp, along with other symptoms. Signs of infection include fever, pain, swelling, redness, and warmth in the affected area. Sometimes a child may refuse to walk at all. Any youngster who develops these symptoms should be taken quickly to the pediatrician or to the emergency room, according to Dr. Onel.

Although less common than other conditions affecting toddlers, children, and adolescents, a bone or joint infection is considered a medical emergency. Prompt treatment with antibiotics, and sometimes surgical drainage, is important to stop the risk of joint damage and other problems.