What are growing pains?
The term "growing pains" refers to a benign (not dangerous) pattern of pain in the limbs. This pain usually occurs in children aged 2 to 12. These pains are the most common type of limb pain in children. Between 10% and 35% of children will have these pains at least once. These pains occur in both boys and girls but slightly more common in girls.
Are these pains associated with growing?
Because these pains most often occur during years when the child's growth is not at its fastest rate, the pains are NOT associated with growing. The name was given in the 1930s to 1940s when the pains were thought to be from faster growth of the bones when compared to the growth of the tendons. We know today that this is not true. The name has remained despite our new understanding of these pains.
Symptoms and Causes
What causes growing pains?
We do not know the cause of growing pains, but there are several theories. Many children with these pains are very flexible (hypermobile) with flat feet. Some children with these pains have a low pain threshold and may also have headaches and abdominal pain. One study found that children with these pains have less bone strength than the normal population. Therefore, pain on a day of increased physical activity may mean the child may have pain from "overuse" of the legs.
What are the symptoms of growing pains?
Growing pains occur mostly in the legs (shins, calves, behind the knees or thighs), and affect both sides of the body. The pain appears late in the day or at night, often awakening the child. By morning the child is well, with no pain or stiffness. Parents often report that they can predict when the pain will occur, often on days of increased physical activity or when the child is tired and grumpy. The duration of the pain is usually between 10 and 30 minutes, although it might range from minutes to hours. The degree of pain can be mild or very severe. Growing pains are intermittent, with pain-free intervals from days to months. In some children the pain can occur daily.
Diagnosis and Tests
How are growing pains diagnosed?
Before diagnosing growing pains, the healthcare provider needs to rule out other potential causes for the pain. The diagnosis is made in children with typical symptoms after a normal physical examination. It is important to stress that these pains are almost always on both sides of the body and disappear by the morning. If the child has only one-sided pain that almost always occurs on the same side of the body and/or has pain or stiffness in the morning, an evaluation for an alternative diagnosis should be performed. In some cases, there may be a need to perform laboratory tests and X-ray studies to exclude other diagnoses.
Management and Treatment
What is the treatment?
Before initiating treatment, the health care provider should make sure that the child and his or her parents understand what the condition is and that the nature of the pains is not serious. During pain episodes, massaging the painful areas and/or giving mild pain medications (e.g., Tylenol ®, ibuprofen) may help. In children with very frequent episodes – especially children who awaken at night – an evening dose of a long-acting pain medication like naproxen may prevent or decrease the pain. Patients with flat feet may benefit from a shoe insert to increase the arch on the inner side of the foot.
Outlook / Prognosis
What happens when the child gets older?
Growing pains are not associated with any serious organic disease and usually resolve by late childhood.