Lameness is a frequent reason for admission to the pediatric emergency department. Evaluation of the limping child can be complex for the clinician. In most cases these are benign causes, however, it is necessary to take into consideration which diagnoses should not be overlooked. Lameness presents a challenge to the pediatrician, who must seek a balance between the need to identify serious conditions early and avoid unnecessary potentially invasive and harmful investigations. Therefore, a possible diagnostic approach for use in the emergency department aimed at early identification of the most serious etiologies is described