The Toddler Who Stopped Walking

Natasha Alexander MBBS
Angela Punnett MD
Pediatric Hematology Oncology Fellow & Staff
The Hospital for Sick Children Toronto, ON

A previously mobile 15-month-old child, Sadie, presents to the emergency room with leg pain and refusal to walk for eight days. She has had a low-grade fever for five days and has seemed more tired than normal. She has lost weight over the last four weeks and her gait has changed. She visited her pediatrician on two occasions, where she was diagnosed with a viral illness. Her past medical history is unremarkable and her development is normal, including walking from the age of 11 months.

On examination, she is a thin child (25th percentile) who is crying and iritable. There is no lymphadenopathy or abdominal masses; there is a palpable liver edge of 3 cm. Neurological examination is normal in upper limbs and she is moving both legs. The right leg has more strength than the left and there is reduced tone in her legs as well as absent reflexes in her lower limbs. She cries in pain on passive movement of the limbs. The bladder is not palpable. She refuses to walk but is seen crawling.

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