Because limping is not normal, many parents will seek medical care for a child who limps, refuses to walk, or complains of limb pain. It is not uncommon for these children to present to the emergency department (ED) for evaluation and treatment. The differential diagnosis for a child with lower-extremity limb pain or limping is quite broad, but fortunately only a few conditions require urgent treatment. The emergency physician must develop a systematic approach to these patients to allow early identification of conditions requiring urgent treatment. This article focuses on the clinical evaluation of children with limb pain to include key elements of the history and physical examination, appropriate diagnostic tests, and disposition of patient. Some of the more common urgent and age-specific diagnosis of limb pain and limping will be discussed in detail at the end of the article.