TY - JOUR T1 - The limping child — when to worry and when to refer: a GP’s guide JF - British Journal of General Practice JO - Br J Gen Pract SP - 467 LP - 467 DO - 10.3399/bjgp20X712565 VL - 70 IS - 698 AU - Hassan Raja AU - Shehzaad A Khan AU - Abdul Waheed Y1 - 2020/09/01 UR - http://bjgp.org/content/70/698/467.abstract N2 - A paper by the King’s Fund in 2010 identified that GPs were more likely to refer younger children than older children with equivalent needs, suggesting lower confidence levels and lower thresholds for referrals.1 An estimated 30% of GP consultations are musculoskeletal2 and a quarter of all patients who visit their GP each year are aged <18 years.3 It is, therefore, important that GPs have a comprehensive understanding of common paediatric orthopaedic pathologies.A limp is a common reason for a child to present to the GP. It is also one of the commonest referrals to the on-call orthopaedic team, due to the long list of differential diagnoses, some of which require urgent treatment.This article outlines an approach to assessing a child with a painful limp and indications for referral to specialist services.There are many causes for a limp in a child; many are age specific (Box 1).All agesFracture/soft-tissue injuryCellulitisNon-accidental injury (NAI)NeoplasmSeptic arthritisNeuromuscularOsteomyelitisAge 1–3 yearsAge 4–10 yearsAge 11–16 yearsSeptic hipDevelopmental dysplasia of the hip (DDH)Toddler’s fracturePerthes’ diseaseTransient synovitisSlipped capital femoral epiphysis (SCFE)Juvenile rheumatoid arthritisOsteochondritis dissecansOsgood–Schlatter diseaseBox 1. Common conditions to consider when assessing a limping child, with age relevanceIt is important to take a detailed history from the patient, if possible, and parents. A key starting point is establishing whether the limp is secondary to trauma or atraumatic. Non-accidental injury (NAI) should always be … ER -