What is it about ?
Children under the age of six often have a hard time being clear about where they are in pain. That’s why it’s helpful to know what can cause a toddler or toddler to refuse to walk or to limp.
The two most common causes for which a young child (suddenly) refuses to put one foot in front of the other are
- an accident with injury (a trivial effusion of blood or a fracture)
- a transient “sterile” joint infection of the hip, several weeks after a viral infection.
In addition, other conditions, more rare, can also cause lameness or problems walking:
- bacterial infection of a bone (osteitis) or a joint (arthritis),
- hip problem,
- rheumatic disease,
- abuse,
- leukemia or other malignant disease.
How to recognize it?
The reason a child refuses to put one foot in front of the other or limps is pain. The origin of the problem may be local, such as an effusion of blood or a fracture from a fall. So always be careful if you see bruises. If so, also see if there are any elsewhere.
If inflammation occurs, you will see localized swelling, redness, and warmth. You can get a pretty good idea by touching it with the back of your hand, and comparing the right and left sides.
General symptoms such as fever and loss of appetite are also signs of a bacterial infection. Also watch for when complaints appear. Pain at rest is more indicative of a joint infection, while pain when moving, during or after walking is more indicative of a tendon or bone injury.
Lameness that lasts more than 7 days is in principle always serious and requires additional examinations.
How is the diagnosis made?
The doctor will ask you questions about the progress of the complaints:
- How did the lameness start? Is there an accident causing the problem? Did it happen suddenly or gradually?
- Is your child always limping? Do you notice a connection with periods of rest, exertion or sport, a poorly cured disease?
- Does your child complain of pain? Does he have pain at rest?
- Has your child recently been ill?
- Is there a fever?
Then, he will also ask if you notice a “morning stiffness”, and possibly if there are any cases of muscle diseases (myopathies) in the family.
The doctor finally examines the back, hips, knees, lower legs and feet. The child will be asked to walk and perform tests such as walking on toes and heels, standing on one leg, squatting and standing up. This gives him an idea of where the problem is, the degree of pain, if there is limitation in movement, if it is an inflammatory reaction, etc. These tests can also give him an indication as to the affected structure: bone or joint, or rather muscle or nerve.
What can you do ?
The most common causes of lameness are trauma from falls or bumps and transient inflammation of the hip. The best thing to do is not to use the affected leg for a few days. The child will not walk if he feels pain anyway. If the pain goes away on its own, he will resume walking on his own. If there is improvement within 3 days, further examinations are not really necessary. If the complaints last more than a week and there are other symptoms, you should see the general practitioner. He can assess the cause and, if necessary, refer you to a specialist for further examinations.
What can your doctor do?
If there are no worrying signs from the tests, the doctor will wait and ask you to watch your child. He then only prescribed rest and a simple painkiller like paracetamol. Anti-inflammatory drugs for a short time reduce the signs of inflammation. The doctor will re-examine your child if the problems worsen or persist for more than a week.
If the doctor suspects a problem with a joint (hip, knee, ankle or toes), he will refer you to the specialist for additional examinations, such as an x-ray, a blood test and possibly a bone scan. An ultrasound of the hip, knee, or ankle is only done when the doctor suspects an inflammatory reaction. This examination allows him to observe the presence of fluid in the joint.
Want to know more?
- Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
- Non-steroidal anti-inflammatory drugs – CBIP – Belgian Center for Pharmacotherapeutic Information
- My child is going to have an ultrasound – Plaster
- My child is going to have an X-ray – Plaster
- My child will have a CT scan – Plaster
- Blood test explained to children – plaster
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