Hip Pain in Children
This guideline applies to children from birth to 17 years.
Introduction
A limping child can be a challenging presentation to diagnose and manage. The pain can be well localised to the hip or referred pain from e.g. bony malignancy, spinal problems, musculoskeletal causes, UTI or appendicitis.
In scope
- Atraumatic hip pain
Not in scope
- Hip pain following trauma
Red Flag Features
- Unwell child with or without fever
- Fever ≥38.5º within preceding week
- Reluctance or inability to weight bear at all (with or without analgesia)
- Severe pain on passive movement
- Sudden onset out-toeing (symmetrical or asymmetrical)
- Acute onset of severe pain
- Pain waking at night
- Boney lump and/ or bony tenderness
- Fatigue/ anorexia/ weight loss/ night sweats
- Limp > 7 days and not previously assessed
- Limp > 14 days and no proven diagnosis
- Concerns of non-accidental Injury
- Leg length difference
Follow the RCHT Acute Atraumatic Limp in Children Clinical Guideline for acute assessment of red, amber and green features and corresponding urgent and emergency management
Investigations required in Primary Care prior to referral
Please refer to Acute Atraumatic Limp in Children Clinical Guideline and manage patients depending on red/amber/green features.
Differential Diagnosis of hip pain in children:
Advice and Guidance
Same day advice is available by contacting the Paediatric Consultant advice phone: 07973 742812 Monday to Friday 09:00 to 21:00.
Referral instructions
Emergency and red and amber flags:
Please follow the Acute Atraumatic Limp In Children RCHT Guideline for acute assessment and management
In afebrile and systemically well children, consider Slipped Upper Femoral Epiphysis. (SUFE)-in children aged 9-17 years with restricted internal rotation. Please follow Acute Atraumatic Limp In Children RCHT Guideline for acute assessment and management .
If SUFE has been confirmed on an x-ray requested in primary care, please refer to PAU.
Urgent referral criteria:
Refer to Paediatric Hip Clinic (only when red and amber flags have been excluded):
- Any child with hip pain
- Or any child with knee pain and an abnormal hip X-ray
- AND pain that persists for over 48 hours and not relieved by paracetamol
Supporting Information
For professionals
For patients
Page Review Information
|
Review date |
07 May 2026 |
|
Next review date |
07 May 2028 |
|
Clinical editor |
Dr Melanie Schick |
|
Contributors |
Dr Tom Fontaine, Consultant Paediatrician, RCHT, Dr Russell Hawkins, Consultant Surgeon in Trauma & Orthopaedics RCHT |