Hip Pain in Children
Limping Child
Please follow the Acute Atraumatic Limp In Children RCHT Guideline for acute assessment and management
AcuteAtraumaticLimpInChildrenClinicalGuideline.pdf (cornwall.nhs.uk)Red Flags Discuss with on call Paediatrics for same day assessment
- Unwell child with or without fever
- Fever ≥38.5º within preceding week
- Inability to weight bear at all (with or without analgesia)
- Severe pain on passive movement
- Acute onset of severe pain
- Pain waking at night
- Boney lump and/ or boney 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
Additional red flags:
Reluctance to weight bear
Sudden onset outtoeing, symmetrical or assymmetrical
See RCHT guideline above for amber and green flags, including when to follow up.
If no red risk factors on assessment, all patients with symptoms lasting > 7 days should have FBC, film, CRP and x-ray under Paediatrics.
Please note Children aged 9-16 with restricted internal rotation indicates slipped upper femoral epiphysis. Please follow the above guidelines.
Can refer as urgent to Paediatric Hip Clinic (red flags excluded):
- Any child with hip pain
- Or any child with knee pain and an abnormal hip X-ray
- And that persists for over 48 hours and not relieved by paracetamol
Investigations to do when referring
- AP Pelvis X-ray AND Frog lateral X-ray
(Frog leg lateral views are routinely performed in children with hip pain aged ≥ 8 years)
Information on Developmental Dysplasia of the Hip available here
Date reviewed 04/02/2022
Next review due 04/02/2023
Sifter name Dr Rebecca Hopkins
Consultant name + any other contributors Dr Natalie Dawes
Version No. 1.1