Introduction

In countries where poliomyelitis has been eradicated, GBS remains the most common cause of acquired paralysis in children. For a classical presentation, making the diagnosis is relatively simple. However, presentation may be subtle and includes minor changes of gait or refusal to walk, associated with pain.

Learning Bite

The emergency physician needs to keep GBS in the differential diagnosis of the limping child.

Factors which make GBS a less likely diagnosis include a fever at presentation, raised cerebrospinal fluid white cell count (CSF WCC), an atypical presentation, or history of travel to developing countries (see Fig 1).