Pediatric Limp Treatment & Management

Updated: Sep 20, 2019
  • Author: Brian Wai Lin, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Treatment

Prehospital Care

Splinting and transportation make up the majority of services that prehospital personnel render to a limping patient.

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Emergency Department Care

Emergency care of the limping patient is broken into 4 components:

  • Relief of acute pain

  • Identification of the cause

  • Initiation of therapy for the source of the limping

  • Referral to the appropriate health care professional for follow-up care

Reduction of dislocations and displaced fractures reduces discomfort and may restore perfusion in cases of vascular compromise.

In cases of suspected osteomyelitis, diskitis, or septic joint, intravenous antibiotics should be initiated as soon as diagnosis is confirmed.

Acetaminophen or ibuprofen usually is adequate for pain relief, although opiates or local or regional anesthesia may be required for more painful or extensive conditions.

For fractures, sprains, and acute traumatic injuries, immobilization with home care instructions to rest, ice, and elevate the injured area may suffice to provide pain relief.

Whenever crutches are dispensed or prescribed, the provider has a duty to train the patient in the proper application, including walking forwards and backwards, plus ascending and descending a few steps. Document training in a chart note.

Various fractures and sprains may require splints; prefabricated knee immobilizers and short leg walker boots may be useful in weight-bearing injuries.

If suspicion of septic arthritis, osteomyelitis, or neoplastic disease is strong, the child should be admitted to a pediatric service with appropriate pediatric consultative services.

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Consultations

In most cases, the diagnosis is clear and no further consultation is necessary. Specific conditions may require consultation from the following specialists:

  • Orthopedic surgeon

  • Infectious diseases specialist

  • Neurologist or rheumatologist

  • Neurosurgeon

  • Child protective services: Any child with an unexplained fracture or injury should be referred for evaluation by Child Protective Services.

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Long-Term Monitoring

All children with a limp should have close follow-up visits with their pediatrician or primary care physician within 24 hours of their ED visit. Any persistence of a limp without cause should be investigated further.

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