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[Lameness in children: diagnostic process].
1Service de chirurgie orthopédique pédiatrique, hôpital Necker-Enfants-Malades, Paris, France. celine.cadilhac@nck.ap-hop-paris.fr
Summary
A thorough physical and diagnostic workup is essential for children with limps to rule out serious conditions like infections or tumors before considering growing pains. Early detection and treatment are crucial for favorable outcomes.
Area of Science:
- Pediatric Orthopedics
- Pediatric Rheumatology
- Pediatric Infectious Diseases
Context:
- Limping in children necessitates a comprehensive evaluation to exclude serious underlying pathology.
- Standard diagnostic protocols include physical examination, plain X-rays, and blood tests (ESR, CRP).
Purpose:
- To outline the essential diagnostic steps for evaluating limping in children.
- To emphasize the importance of excluding infectious and tumoral processes.
- To guide clinicians in the appropriate work-up before diagnosing growing pains.
Summary:
- A complete physical examination, including neurological assessment and evaluation of the lower limbs and spine, is mandatory for all children presenting with a limp.
- Initial investigations should include pelvic and hip X-rays, along with blood tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), to rapidly rule out infectious or tumoral etiologies.
- Further investigations and repeat assessments may be required in specific cases to establish an accurate etiological diagnosis, underscoring that bone pain in children often indicates a pathological process that must be addressed before attributing it to benign 'growing pains'.
Impact:
- Ensures timely diagnosis and treatment of potentially serious pediatric conditions.
- Reduces misdiagnosis of pathological limps as benign growing pains.
- Provides a clear diagnostic pathway for clinicians managing pediatric limps.