Toddler limping for over two weeks with clear tests

[ForNattyAquaWasp]

Hey,
I have a 2.5-year-old daughter who has been limping for over 2 weeks, and I’m desperate for some advice.
She had transient synovitis last November, but this time the limp has lasted much longer and wasn’t preceded by a viral infection. Transient synovitis has now been ruled out as there was no fluid found in either hip.
We’ve been back and forth between the GP and A&E multiple times. She’s had several X-rays, blood tests and ultrasounds of her hips and knees, all of which have been clear. Despite the limp progressively getting worse, we’ve repeatedly been sent home and told to wait a few more days.
We even saw a private podiatrist, who said they couldn’t help without a diagnosis. Our GP contacted the hospital’s paediatric team, who advised us to return to A&E, but after yet more tests today, we were sent home again and told to go back to the GP.
I’m really struggling because I know my child isn’t right, yet everyone keeps telling us she’s fine. Has anyone experienced anything similar or have any advice on what we should ask for next?

Has anyone tested for leg length discrepancies?

Is she in pain during the examinations? Could it be that she's copying someone else with a limp? Grandparents with a limp?

Not a real suggestion but you've made me remember something. Toddler ds was limping when I let him walk round a shopping centre for a bit when he was restless in the buggy. .
Got him home and he had a domino in his shoe !
He hadn't even cried or complained..
I hope you find answers soon op.

She’s been checked for discrepancies and there is none. She also is not copying any grandparents. She has been waking up at night screaming with pain and sweating (which is new) as well as a loss of appetite and way more tired. She’s only 2 so we take what she says with a pinch of salt however she does complain of both knees hurting on and off during the day.

My DS had a suspected 'toddler's fracture' at 2. He went to bed fine and woke up with a limp.

'Toddler's fracture — a small spiral fracture of the shin bone; it can be invisible on the first X-ray.'

The night sweats, limp, tired and lack of appetite are red flags. I'd be camping out in A&E.

I wish it was something like this because at least we would have answers. we’ve been sent back and forth from gp to a&e 5 times over past 2 weeks. They have done 3 scans now 2 X-ray and 1 ultrasound. I hope he was okay!

I have absolutely zero medical knowledge so please feel free to completely ignore me, but do they do a full body CT scan on a toddler, ie. from head to toe?

Yep exactly why our GP has sent us there 3 times now. We’ve been 5 times in past 2 weeks they are running tests but just don’t seem to give us any answers, and essentially tell us to keep coming back if it persists.

This. What has she been tested for? Have they done blood tests?

She’s had 2 blood tests, first one they said was fine she was just anaemic which is normal for toddlers they said. Second one was “it’s fine you can go home”

What have they ruled out? Paget's disease by any chance? A family member of mine had cystic fibrous dysplasia when they were 8, it required surgery and a metal plate in their leg.

I’d go back to a+e this weekend with the night sweats and pain as these are new

Hey

so children don’t usually fake a limp - ignore people who say that.

id go back to A&E ideally specifically a children’s hospital, and be polite but firm.

state you’re not leaving until she is admitted and gotten to the bottom of this.

id state very very clearly that you have been back and forth over the past several weeks with no answers

the GP won’t be able to get to the bottom of it if A£E can’t.

She needs more testing which your GP can’t do (in office obviously can refer her) but your GP is not a paediatrician

it’s really hard but I’d lay your cards out in the table, explain what you’ve done yourself and essentially say if this was your child how would you feel.

see if you can speak to a more senior doctor if you haven’t been seen by a consultant previously

be polite but firm, you are not leaving.

unfortunately paeds is very specialised and your DD is still very little so the only people able to get to the bottom on this is as MDT paediatric team.
sometimes in the NHS you need to make a bit of a fuss unfortunately

(no shade to the NHS I think they’re wonderful once you’re under the right team, but it can be incredibly frustrating)

best of luck

They’ve just said her blood tests prove she hasn’t got septic Arthritis, arthritis, leukaemia, inflammation or infection. They also said her x ray and ultrasound rule out fluid and fractures.

I’m a paediatrician.
I don’t know why your daughter is limping, but as your GP said the other symptoms you have mentioned are concerning. Has she had more than one set of bloods and x-rays?
Has she been seen by a paediatric consultant? Please do return and specifically request this. If all tests negative so far and symptoms persisting then a rheumatology review might also be warranted.

I just saw the bit about night sweats / weight loss / waking at night

go to A&E tomorrow

cancel any plans you may have

pack an overnight bag

do not go home those are red flags

Do you have a children’s hospital near you?

Yes she was seen by paediatric consultants in a&e the last two times we’ve been this week. Both times we’ve been told she’s healthy and to come back if she gets new symptoms or it doesn’t go away.

We’ve been so many times this week and unfortunately keep getting sent home no matter how much me and her dad question them. First 3 visits this week they put it down to transient synovitis but today it was ruled out as her ultrasound showed no fluid. It’s a specialised children’s hospital also.

Good to hear she’s had all the appropriate first line tests. It’s somewhat reassuring that a lot of the serious things have been ruled out it sounds like, but I understand why you’re still worried.
Sometimes toddler fractures don’t show on initial X-rays so this is still a possibility.
It feels unsatisfactory but I think have others have said you will just need to re-present if she’s getting worse. Orthopaedics and rheumatology may be additionally useful to be consulted if they haven’t already.

I was told today that orthopaedics won’t see her as her blood tests were clear in their words. I may just need to keep going back. Thank you for your advice though!

I’d be pushing for an MRI if she was my child, however would need to be done under general anaesthetic (as she won’t/can’t lie still long enough). I’m a paediatric anaesthetist and I’ve done many many limping toddler MRI scans- may well be normal and GA for nothing but it would reassure me nothing missed.

I’m not medical but could it be kingella kingae

In our region, we have been told that the wait for a GA MRI is now 69 weeks. If they can cope with sedation, we can get them in locally within a couple of weeks.

National picture I think which is dire, but if this limp doesn’t resolve this is the type of problem where we would expedite this. I regularly do them on my on calls ad hoc.