Toddlers have an immature gait pattern, characterized by a broad-base, increased flexion of hips and knees, with arms beside the body and elbow extended, all to improve the swing phase of a naturally unbalanced gait. Unable to increase the size of their steps because of neuromuscular immaturity, toddlers increase their pace with the aim of gaining speed.¹
| Toddler (0-4 years) | Child (5-10 years) | Adolescent (>10 years) |
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* Slipped Capital Femoral Epiphysis (SCFE)
An antalgic gait, characterized by shortening of the stance phase of gait, is a compensatory mechanism adopted to prevent pain in the affected leg. Because there is decreased contact between the affected leg and the ground, a child with such a gait may not report pain.²
There are several different types of non-antalgic gait; most of these do not require urgent evaluation and treatment.
Red-flags on Presentation:
- symptoms for more than 7 days
- severe localised joint pain (septic arthritis)
- change to urinary or bowel habit
- complete inability to walk or weight-bear
- nocturnal pain and symptoms
- systemic symptoms: fever, night sweats, chills, rigors, rash
- constitutional symptoms e.g. unplanned weight loss, lethargy / easy fatigue, anorexia (consider malignancy / haematological cause)
- generalised wasting
- fever
- Petechiae, purpura, or ecchymosis³
References
- Santili, Cláudio et al. “Limping in Children.” Revista brasileira de ortopedia vol. 44,4 290-8. 8 Dec. 2015, doi:10.1016/S2255-4971(15)30156-7.
- Sawyer, Jeffrey R. and Kapoor, Mukesh. “The Limping Child: A Systematic Approach to Diagnosis.” Am Fam Physician. 2009 Feb 1;79(3):215-224.
- The limping or non-weight bearing child. Clinical Practice Guidelines. The Royal Children’s Hospital, Melbourne. Available at Clinical Practice Guidelines : The limping or non-weight bearing child (rch.org.au).
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Diagnosis of Children with an Antalgic Gait (AAFP, 2009)