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The Limping Child: A Guide for the Trainees
Norah AlRohaimi1,2,3, Hamad Alkhalaf1,2,3, Jubran Alqanatish1,2,3
1Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia.
Insights
Limping in children presents a diagnostic challenge due to many causes, from normal development to infections. This guide helps physicians identify common causes and understand gait analysis for better diagnosis.
Area of Science:
- Pediatric Rheumatology
- Pediatric Orthopedics
- Pediatric Gait Analysis
Background:
- Limping is a frequent pediatric complaint, yet its diverse origins pose diagnostic difficulties.
- Causes range from developmental variations to systemic inflammatory diseases, infections, and rare non-musculoskeletal issues.
- Diagnostic challenges are amplified in younger children due to examination limitations.
Purpose of the Study:
- To provide a practical guide for pediatric trainees on approaching a limping child.
- To outline common etiologies of childhood limping.
- To enhance understanding of normal and abnormal gait cycles in pediatric assessment.
Main Methods:
- Review of clinical assessment strategies for pediatric limping.
- Emphasis on gait analysis to guide diagnostic testing.
- Discussion of common and uncommon causes of limping in children.
Main Results:
- A structured approach to pediatric limping is crucial for accurate diagnosis.
- Gait analysis serves as a key tool in directing laboratory and imaging studies.
- Understanding developmental gait variations is essential.
Conclusions:
- This guide aims to equip General Pediatric and Pediatric Rheumatology trainees with the knowledge to effectively diagnose limping children.
- Early and accurate diagnosis is vital for appropriate management of pediatric limping.
- Comprehensive assessment, including gait analysis, improves diagnostic yield.
Abstract:
Limping is a common presenting complaint in children. Despite this, it remains to be a diagnostic challenge for treating physicians due to an expanded list of etiologies. It arises from a spectrum of disorders, ranging from physiological variations of gait at different stages of development to systemic causes, such as inflammatory diseases or musculoskeletal infections. On rare occasions, non-musculoskeletal causes could result in limping. The diagnostic challenge increases in younger age children where a detailed physical examination that helps identify the exact source of pathology may not be possible. In older patients who have a well-developed gait cycle, the physical assessment might be easier. Clinical assessment in a child presenting with a limp includes gait analysis, which is essential to guide the appropriate request of diagnostic laboratory tests and imaging studies. In this paper, we provide a practical guide for a trainee in General Pediatric and Pediatric Rheumatology on an approach to a limping child, aiming to identify the common causes of limping and to describe normal and abnormal gait cycles. We also discuss other diagnostic considerations in the assessment of these children.
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