Differential Diagnosis for Leg Pain in a 13-Month-Old Who Can't Bear Weight
Single Most Likely Diagnosis
- Toddler's fracture: A common injury in toddlers, often resulting from a minor trauma or stress fracture, which can cause significant pain and refusal to bear weight. The age and presentation make this a highly plausible diagnosis.
Other Likely Diagnoses
- Infectious causes (e.g., osteomyelitis, septic arthritis): Bacterial infections can cause severe leg pain, fever, and an inability to bear weight. These conditions are more common in young children and can be serious if not promptly treated.
- Trauma (e.g., fractures other than toddler's fracture): Other types of fractures or soft tissue injuries from falls or accidents can also lead to leg pain and an inability to bear weight.
- Transient synovitis: Although more commonly associated with hip pain, transient synovitis can sometimes cause leg pain and is a consideration in a child who is refusing to bear weight.
Do Not Miss Diagnoses
- Malignancy (e.g., neuroblastoma, osteosarcoma): Although rare, malignancies can present with leg pain and must be considered to avoid delayed diagnosis and treatment.
- Non-accidental trauma: It's crucial to consider the possibility of child abuse, especially if the history provided does not match the injury or if there are other suspicious findings.
- Slipped capital femoral epiphysis (SCFE): More common in older children but can occur in younger ones, especially if there's an underlying condition affecting bone health.
Rare Diagnoses
- Legg-Calve-Perthes disease: A rare condition characterized by avascular necrosis of the femoral head, which can cause hip and leg pain.
- Juvenile idiopathic arthritis: An autoimmune condition that can cause joint pain and swelling, including in the legs, though it's less common to present with an acute inability to bear weight.
- Neurological conditions (e.g., peripheral nerve injuries, spinal cord lesions): These can cause leg pain and weakness but are less common in this age group and presentation.