Limping in children
A limp is not a diagnosis. It is the way a child protects whatever hurts: a shorter step on one side, a foot turned outwards, weight taken only on the toes…
On this page
- A limp that "sorts itself out" does not exist
- When it cannot wait until morning
- What happens in younger children
- What happens in teenagers
- The knee hurts and the hip is to blame
- When a limp makes doctors look for a tumour or leukaemia
- If the child does not talk yet
- How a doctor works out the cause
- What to do at home, and what not to do
- Online consultation
Medicines commonly prescribed for Limping in children
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: TABLET, 500 mgActive substance: paracetamolManufacturer: Galenicum Vitae S.L.Prescription requiredDosage form: TABLET, 1000 mgActive substance: paracetamolManufacturer: Mylan Pharmaceuticals S.L.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 100 mg/mlActive substance: paracetamolManufacturer: Industria Quimica Y Farmaceutica Vir S.A.Prescription required
A limp is not a diagnosis. It is the way a child protects whatever hurts: a shorter step on one side, a foot turned outwards, weight taken only on the toes, or simply sitting down on the floor and refusing to go any further. The cause can lie anywhere between the toe and the lower back, and it is rarely obvious from looking. This page sets out what causes limping, which signs mean a child needs a hospital now rather than tomorrow, and why a limp with no clear explanation is never left to be watched for a week.
A limp that "sorts itself out" does not exist
If your child starts limping and you cannot confidently say why, the child needs examining. Not watching for a week, not resting it off, but seen by a doctor. This is the central rule of the subject, and it is not over-caution: among limping children we find joint and bone infection, a slipped femoral head, tumours and leukaemia, and here the price of a few lost days is not measured in convenience but in outcome.
It is a different matter when the cause is obvious and you saw it happen: a twisted ankle in the playground, a heel rubbed raw by new trainers, standing on something sharp. That kind of limp really does settle in a day or two. Check the whole foot, including the sole and between the toes: a splinter, a deep callus, an ingrowing toenail or a verruca on a weight-bearing spot will make a child limp as convincingly as a fracture, and each takes a minute to find.
One more thing about children. They do not limp out of mischief, and they almost never keep up a pretend pain for more than a few minutes. A child who has stopped running and wants to be carried is telling you something real. A limp lasting more than two or three days, getting worse, or coming back after it had gone, deserves examination whether or not there was an injury.
When it cannot wait until morning
The clock runs in hours with a pus-forming infection inside the joint (septic arthritis) and an infection of the bone itself (osteomyelitis). Pus destroys cartilage and the growth plate quickly, and what is lost does not come back; treatment happens only in hospital, washing out the joint and giving antibiotics into a vein. What gives it away is how the child looks overall: ill, rather than merely limping.
Call an ambulance on the single European number 112, or take your child straight to hospital, if:
- the child will not put any weight on the leg and cannot take a single step — not limping, but refusing to bear weight;
- the child will not let anyone touch the leg and screams at any attempt to move it;
- there is a fever, especially a high one, or shivering;
- the child is listless, pale, drowsy, refusing drinks, and looks seriously unwell;
- the joint, thigh or lower leg is hot and swollen, with red skin over it;
- the leg is held in a fixed position and cannot be straightened;
- the leg has changed shape or lies at an unnatural angle, or the injury was a heavy one: a fall from height, a road accident, a collision in sport;
- a rash appears that does not fade when a clear glass is pressed against it.
Fever medicine makes a child look better for a while. Judge how they are an hour after the dose, once the temperature has come down — and still go if any of the above happened. A plain inflamed joint and an infected one cannot be told apart by eye, so in any doubt you act as though it were infection.
Same-day review by a doctor, without an ambulance, is right for a child under three, for a child whose pain wakes them at night, for a limp that is getting worse day by day, and for a child who has recently had surgery or a fracture, is having chemotherapy or medicines that suppress the immune system, or has sickle cell disease.
What happens in younger children
Age narrows the list of causes more than any other single fact, which is why a doctor asks the child's age first.
Under three. A toddler who suddenly stops walking, or starts favouring one leg noticeably, most often has a fracture: a fine spiral crack in the shin bone caused by an ordinary trip. The parents remember nothing, because there may have been nothing worth remembering. This age group is also where hip dysplasia picked up late shows itself: the child walked late, waddles, one leg looks shorter. Harmless causes are at their least common here, and the child cannot describe the pain.
Roughly three to ten. The commonest finding is transient synovitis, a short-lived inflammation of the lining of the hip joint, usually one or two weeks after a cold or a tummy bug. The child limps but is otherwise themselves: playing, eating, no fever, and it settles within days. The same age brings Perthes' disease, in which the blood supply to the head of the femur is disturbed: the pain is quiet, but the limp lasts months and does not go away with rest.
What happens in teenagers
The main danger at this age is a slipped upper femoral epiphysis, where the head of the thigh bone slides off along the growth plate. It comes during the fast-growth years and is markedly more common in teenagers carrying extra weight. It begins with a dull ache in the groin, thigh or knee, along with a limp; the foot turns outwards and turning the hip inwards becomes stiff. Sometimes the slip happens abruptly after a trivial movement and the teenager stops weight-bearing on the spot. This is treated surgically, and the less the head has moved, the simpler the operation and the better the hip afterwards.
Far more common at this age are overload pains where tendons attach to bone — under the kneecap, at the heel, along the rim of the pelvis — and in a sudden effort those attachments can pull away with a chip of bone. That kind of pain follows exertion, eases with rest and returns at the next training session.
At any age juvenile idiopathic arthritis is possible: joint inflammation lasting weeks, with morning stiffness that walks off, a swollen joint, other joints joining in, and a duration of more than six weeks. Less often a limp comes from inflammation of the iliopsoas muscle, from spinal disease, from neurological causes, or from one leg simply being longer than the other.
The knee hurts and the hip is to blame
This is the best-known trap in children's orthopaedics, and people still fall into it. A child with a diseased hip very often complains not about the hip but about the knee or the middle of the thigh. The reason is anatomical: sensory branches of the same nerves supply both the joint and the skin over the knee, and the child physically cannot pinpoint the source more accurately.
Hence a rule worth knowing as a parent too: a child complaining of knee pain always has the hip examined as well — even when the knee looks entirely normal, is not swollen and bends freely. If the knee is clean and the child still limps, you look higher up.
The most dangerous version is a teenager with a slipped epiphysis: they arrive with knee pain, the knee is faultless, they are told it is a strain and sent home with a rub and rest, and meanwhile the femoral head slides further. A teenager with no injury who has knee or thigh pain, drags the leg and turns the foot outwards needs examination and X-rays of both hips, not an ointment.
If the limp began with complaints about the groin and thigh and a doctor has already mentioned an irritable hip or transient synovitis, see the separate page on this site about hip pain in children: it goes through how synovitis differs from joint infection, how it is confirmed, and how it is managed at home.
When a limp makes doctors look for a tumour or leukaemia
These are rare causes, but they must be said out loud, because they are recognised by a collection of small things, each of which looks innocent on its own.
Take note of: pain at rest and especially at night that wakes the child; pain in several bones or joints at once; a limp that does not resolve over weeks and has no injury behind it; unexplained weight loss; night sweats; persistent pallor and tiredness; bruises and pinpoint red spots where the child has not been knocked; frequent nosebleeds; enlarged lymph nodes; a firm swelling over a bone that is slowly growing.
A limp and bone pain together with pallor, bruising and enlarged lymph nodes are a reason to have a full blood count done, not a reason to wait. Bone tumours in teenagers often start as "pain after training" that somehow does not go in a month and hurts more at night than by day. All of this is treatable, and the result depends on how early it is started.
If the child does not talk yet
In a child too young to say "my leg hurts", a limp or a refusal to walk is often the only sign there is, and it falls to an adult to notice it.
Take it seriously if the child suddenly stops standing and walking although they were walking confidently; crawls lopsidedly, dragging one leg; cries during a nappy change when the legs are parted; will not let you put a sock or shoe on one foot; keeps the leg in one position and guards it with a hand; has begun waking at night crying.
Such a child is examined the same day. Undress them completely before the appointment and look yourself: for swelling, bruising, redness, a difference in the thickness of the thighs and calves, a wound on the sole of the foot. And take their temperature — in the youngest children that is often the missing piece.
How a doctor works out the cause
The examination starts by watching: the doctor sees how the child walks down the corridor, gets off a chair and lies down on the couch, because much of it only shows in movement. Then they feel the leg from foot to pelvis, check the range of movement in every joint always comparing one side with the other, assess inward rotation of the hip separately, look at the back, the skin and the lymph nodes, and take the temperature.
They will ask what illnesses the child has had in the past two or three weeks, whether there were any falls, whether the shoes have changed, whether similar conditions run in the family, and whether the child has been anywhere with tick-borne Lyme disease. If the picture is unclear, a blood test with inflammatory markers is taken, an ultrasound of the joint is done because it shows fluid inside best, and X-rays in two views are ordered if a fracture, Perthes' disease or a slipped epiphysis is suspected. When the choice is between inflammation and infection, the joint is aspirated and the fluid analysed: that is the decisive test. Sometimes an MRI scan is added, which finds hidden fractures and pockets of infection within bone.
Prepare for the appointment: recall the exact day the walking changed, film a short video of the child walking, and write down the temperature readings and the names of every medicine given.
What to do at home, and what not to do
Home measures only make sense after the examination, once a doctor has named the cause and agreed to treatment at home. Before that, nothing is "treated" at home.
- Rest the leg for a few days: no running, jumping, clubs or school sport. There is no need to put the child to bed — children limit themselves exactly as much as it hurts.
- For pain use children's paracetamol or ibuprofen, measuring the dose by the child's weight as the product information says. Do not combine two preparations containing the same active ingredient. Children and teenagers are not given aspirin.
- Do not warm the painful area, rub it with heat creams or massage it: if the cause is infection, heat makes it worse.
- Do not make the child walk through the pain, and do not coax them into standing on the leg if they cannot.
- Go to the follow-up appointment if one was arranged, even if things have improved: in Perthes' disease and a slipped epiphysis a temporary improvement is deceptive.
- Return to sport gradually, guided by how the child is rather than by a date in the calendar.
Contact a doctor sooner than planned if a fever appears, if the pain gets worse or stops responding to painkillers, if the child bears weight less well, or if the limp lasts longer than two weeks. A limp that drags on beyond two weeks is no longer a passing inflammation, and the diagnosis needs revisiting.
Online consultation
A child's leg cannot be felt through a screen, and an online consultation does not replace the examination. What it does answer is the question a parent asks first: how urgently that examination is needed — right now, today, or at an appointment booked calmly. An Oladoctor doctor will ask exactly how the child limps, whether they bear weight, what they have been doing in recent weeks, whether there is a fever and how the child looks overall, will watch the video of their walking, and will explain which signs call for an ambulance immediately and which allow a calm trip to a clinic. They will help you make sense of tests and images already done and advise which specialist to see. If what you describe sounds like an infection in a joint or bone, you will be told at once and sent to hospital.
This material is for information only and does not replace medical advice.
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