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Chapter 54: Tripping and Falling in a Child

Christy L. Skura; Bach T. Ly

Description of the Symptom

Tripping and falling in the pediatric population are developmental traits that are normal but can be considered pathological if they (1) persist beyond a certain age, (2) present with a sudden onset, or (3) worsen over time. Tripping and falling may or may not be associated with changes in the gait pattern or with pain.

Special Concerns

  • Sudden onset

  • Signs of malfunctioning shunt (ie, ventricular-peritoneal shunt) and spinal cord tethering, such as nausea, vomiting, seizures, fever, decline in motor function, and change in affect

  • Proximal and worsening muscular weakness

CHAPTER PREVIEW: Conditions That May Lead to Tripping and Falling in a Child
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CHAPTER PREVIEW: Conditions That May Lead to Tripping and Falling in a Child
T  Trauma
COMMON
Peripheral nerve injury or entrapment 1066
UNCOMMON
Traumatic brain injury 1068
RARE
Traumatic spinal cord injury 1068
I  Inflammation
COMMON
Not applicable
UNCOMMON

Aseptic

Juvenile rheumatoid arthritis 1064

Septic

Not applicable
RARE

Aseptic

Acute demyelinating polyradiculoneuropathy (Guillain-Barré syndrome) 1061

Secretory otitis media 1067

Septic

Poliomyelitis 1067
M  Metabolic
COMMON
Not applicable
UNCOMMON
Mitochondrial disease 1065
RARE
Hereditary motor and sensory neuropathy Type III (Dejerine-Sottas disease) 1064
Va  Vascular
COMMON
Not applicable
UNCOMMON
Stroke 1067
RARE
Ventriculoperitoneal shunt malfunction 1069
De  Degenerative
COMMON
Not applicable
UNCOMMON

Charcot-Marie-Tooth peripheral neuropathy 1062

Muscular dystrophies:

  • Duchenne muscular dystrophy 1065
RARE

Adrenoleukodystrophy 1061

Cerebellar hypoplasia 1062

Kugelberg-Welander disease (juvenile, type III) 1065

Muscular dystrophies:

  • Becker muscular dystrophy 1065

  • Congenital myopathy 1065

  • Emery-Dreifuss muscular dystrophy 1066

Neuronal ceroid lipofuscinosis (Batten disease) 1066
Tu  Tumor
COMMON
Not applicable
UNCOMMON
Not applicable
RARE

Malignant Primary, such as:

  • Acute leukemia 1068

  • Spinal cord tumor 1069

  • Tumor in proximity to the fourth ventricle or vestibular nuclei 1069

Malignant Metastatic, such as:

  • Pilocytic astrocytoma 1068

  • Posterior fossa tumor 1068

Benign:

Not applicable
Co  Congenital
COMMON

Angular variations of the knees (genu varum; bowlegs or genu valgum; knock knees) 1061

Clubfoot deformity (talipes equinovarus) 1062

Developmental dysplasia of the hip 1063

Down syndrome (Trisomy 21) 1063

Mental retardation 1065

Seizure disorder 1067
UNCOMMON

Attention deficit hyperactivity disorder 1061

Huntington's disease 1064

In-toeing (if severe) 1064

Out-toeing (if severe) 1066

Pes planus (flatfoot, if severe) 1067
RARE

Ehlers-Danlos syndrome 1063

Myelodysplasia 1066

Tethered cord syndrome 1067
Ne  Neurogenic/Psychogenic
COMMON

Autism and pervasive developmental disorders 1062

Cerebral palsy (spastic or ataxic) 1062

Visual impairment 1069
UNCOMMON

Developmental coordination disorder 1063

Sensory processing disorder (including proprioceptive, tactile, and vestibular difficulties) 1067
RARE

Hereditary ataxias:

  • Ataxia telangiectasia 1063

  • Cerebellar ataxia 1064

  • Friedreich's ataxia 1064

Note: These are estimates of relative incidence because few data are available for the less common conditions.

Common Ages at Which Tripping and Falling Present in a Child
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Common Ages at Which Tripping and Falling Present in a Child
APPROXIMATE AGE CAUSES
Birth to 3 Years

Acute demyelinating polyradiculoneuropathy

Acute leukemia

Angular ...

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