Click here to view the limp paediatric pathway.
Limp
Advice for professionals
When should you worry?
If your child has any of the following:
- Is pale, mottled and feels abnormally cold to touch
- Is going blue around the lips
- Becomes extremely agitated, confused or very lethargic (difficult to wake)
- Has a fit / seizure
- Develops a rash that does not disappear with pressure (see the ‘Glass Test’)
- If you think that your child has broken a bone
You need urgent help
Go to the nearest Hospital Emergency (A&E) Department or phone 999
If your child has any of the following:
- Is unable to put any weight on their leg
- Is no better after 48 hours
- Develops a fever above 38.5°C
You need to contact a doctor or nurse today
Please ring your GP surgery or contact NHS 111 - dial 111 or for children aged 5 years and above visit 111.nhs.uk
If your child:
- Continues to have pain/limp that is slowly improving but he/she is otherwise well
Self care
Continue providing your child’s care at home. If you are still concerned about your child, contact NHS 111 – dial 111 or for children aged 5 years and above visit 111.nhs.uk
This content has been developed by healthcare professionals from across the UK in collaboration with the RCPCH.
- Give your child ibuprofen for a few days. You can also give paracetamol to help with the pain
- Your child should rest as much as possible until the symptoms have resolved. You can then allow your child to gradually return to their usual activities
- If your child starts limping, it's usually the sign of a minor injury such as a sprain. However, if they haven't had any obvious injury, they may need to be seen by a healthcare professional to look for other possible causes
- Irritable hip (also known as Transient Synovitis) is a common childhood condition that causes symptoms of hip pain and limping
- However, irritable hip shares some of the symptoms of more serious hip conditions, such as septic arthritis (an infection inside the hip)
- If your child develops a temperature above 38.5°C, their pain is no better after 48 hours or they are unable to put any weight on their leg, they need to be seen urgently by your GP
- Your child should start getting better within a couple of days
- If they are not better within 48 hours, or not back to normal within 7 days, you should arrange for them to be seen by your GP
There are many sensory issues associated with sleep including:
- Sensitivity to sound, touch, and visual stimuli which can be distracting and distressing and can affect the process of falling asleep.
- Interoception difficulties, particularly recognising when hungry, full or thirsty or when the person is tired.
- Some children are more sensitive to foods like sugar, caffeine and additives which keep people awake.
Look at the bedroom environment to see what may be affecting their ability to go to sleep and stay asleep. Do their pyjamas and bedclothes feel comfortable, are they too hot or cold? Is it too light or too dark, too noisy or too quiet? Perhaps it is too cluttered and stimulating. Think about your child’s diet. Are they eating too early or not having enough to eat? Are they eating food that can stimulate them close to bedtime. There can be added difficulties where children have restrictive diets but some simple adjustments of what is eaten and when can make a big difference.
Sticking to the same routine helps your child to know what to expect at bedtime and helps them feel secure. It also helps to support your child’s internal body clock and keep it on track. The age related sleep advice and information on this website can help with establishing routines. Some children will benefit from using picture timetables, timers or social stories to help them understand their bed-time routine. More information about visual supports can be found on these websites
Visual Resources | Autism West Midlands
Visual Supports | Autism Toolbox Autism Toolbox
Your child may be feeling overstimulated after a busy day and needs help to wind down, or their environment may be overstimulating with lots of toys, TVs and computers within reach. Avoiding TV and computers or hand-held devices an hour before bedtime can help your child to wind down. Activities that are good for the wind down period are jigsaws and colouring. Having a relaxing bath and milky drink can help some children, but for some children having a bath can over-excite them so they may need to have their bath earlier in the day.
Children who wake to use the toilet, wet the bed, or who wear nappies or pull-ups at night that need changing may have disturbed sleep. Eric, the children’s bowel and bladder charity are a good source of advice on this topic.
What might help
Keeping a sleep diary
A sleep diary can help you understand what may be causing difficulties with sleep. Fill it out every evening and record as much as you can. You can use it to spot patterns and make changes that may help.
The Sleep Charity have templates you can download; one for teenagers and one for younger children.
Seeking advice and help from sleep services
There are organisations that can help you if you are having difficulties with your child’s sleep. There are many national organisations, including those who specialise in sleep for SEND families, and there are also community-based services in Shropshire, Telford and Wrekin. Click the link at the bottom of page to visit our support services page.
Understanding sleep cycles
The circadian sleep cycle is a 24-hour cycle that helps govern essential bodily functions especially the sleep-wake cycle. It plays a vital role in a person’s ability to sleep in one consolidated block of time at night and to stay awake during the day. As the sun sets in the evening, the brain begins producing melatonin, a hormone that induces sleepiness. Core body temperature also drops.
As melatonin and tryptophan (an amino acid which helps produce melatonin) are naturally produced in the body, there are things you can do to help their production. Darkness helps to promote the production of melatonin which is why it is a good idea to put your child to sleep in a darkened room, and light emitting devices such as tablets and phones also can destroy Melatonin so should not be used for at least an hour before bed. New research shows that limiting exposure to screens and increasing physical activity levels during the day has a positive effect on children's overall physical, mental health and wellbeing, including sleep.
Setting a waking time consistently even in holiday times, called ‘anchoring’ the wake time, can help to reset the body clock over time. This should be accompanied with exposure to lots of light on waking to support circadian rhythm.
Melatonin and tryptophan occur naturally in some foods and drinks such as milky drinks and cereals which is why having a milky drink before bed can help settling to sleep. For more information visit Diet & Sleep - The Sleep Charity
Prescriptions of melatonin
Behavioural strategies and practical solutions are the best way to address sleep difficulties, but if they are having a significant impact on your child’s ability to function, a drug form of melatonin is sometimes prescribed for neurodivergent children. As the drug’s function is to re-set sleep and wake cycles, it works best combined with good sleep hygiene practices. It is important that is it taken under medical supervision and not purchased on-line so that it is closely monitored for dosage and side effects. It should be prescribed for the shortest period necessary as the long-term effects of the drug on children’s development are not yet known.
In Shropshire, Telford and Wrekin the Community Paediatric Service and the BeeU Service (CAMHS) can prescribe Melatonin for children and young people who meet ALL of the following criteria.
- the child/young person must be open to and being treated by the service due to a neurodevelopmental/mental health need (diagnosis not required)
- sleep issues are causing significant impact on the child/ young person, for example due to daytime sleeping or behavioural problems that are impacting daily functioning or educational attendance
- behavioural approaches have been tried and failed. These may have been offered by the service (where available) or by community sleep support services.
GPs are unable to prescribe Melatonin although they sometimes issue repeat prescriptions when prescribing has been started by a specialist (such as a paediatrician or child psychiatrist).
Further support
Click on the link below to visit a page with information about
- national websites and sleep organisations
- local community services in Shropshire, Telford and Wrekin.