Limp / Child Not Weight Bearing

First actions / assessment

• Assess ABCDE if unwell, then confirm whether the child is truly non-weight bearing or just limping. Clarify onset, duration, trauma, fever, recent viral illness, preceding sore throat or diarrhoea, pain site including hip pain referred to thigh or knee, night pain, morning stiffness, rash, bruising, weight loss, refusal to use limb, and analgesic response. Observe gait if possible. Examine the entire limb above and below the apparent site, and remember that hip pathology can present as knee pain. Assess active and passive range of motion of all relevant joints
• marked reduction suggests significant pathology such as septic arthritis. Examine abdomen, spine, scrotum, neurovascular status, and other joints if indicated. Investigations depend on presentation: X-ray of area of suspicion
• pelvis AP or frog-leg view may help identify SUFE/SCFE, Perthes disease, or pelvic avulsion injuries, although frog-leg view should be avoided if SCFE is strongly suspected locally