Limp (peds)


  • It can be difficult to differentiate hip from knee pain in children
    • Knee pain can be referred pain from the hip

Clinical Features

  • Pediatric patient with a reported limp with ambulation
  • May additionally have leg, hip, and/or knee tenderness to palpation

Differential Diagnosis

Pediatric hip pain

Other causes of limping



  • X-ray hip (AP & bilateral frog-leg view), femur, knee
  • Consider CBC, ESR, total CK
  • Blood culture if febrile.[1]
  • Consider:
    • Ultrasound to evaluate for effusion
    • CT to evaluate for abscess

Kocher Criteria for septic arthritis of the hip

  • ESR > 40 mm/hr
  • WBC > 12,000/microliter
  • Refusal or inability to weight bear on affected joint
  • Fever 38.5° C or greater
Number of Kocher Criteria Chance of Septic Joint
1 3%
2 40%
3 93%
4 99%



See Also

External Links