Musculoskeletal symptoms in children are among the most frequent presenting symptoms. Besides traumatic etiology - which accounts for most of the symptoms- more than 100 differential diagnoses need to be considered in the pediatric patients. Therefore children with limp pain or gait abnormalities always require thorough assessment for early exclusion of potentially threatening diseases e.g. leukemia, chronic metabolic or inflammatory diseases. Pediatric patients with arthralgia or arthritis therefore represent a population of risk which should always require referral to the experienced pediatrician whenever the diagnosis or condition of the child remains uncertain.