Growing Pains in Children: What You Need To Know with Dr. Lainie Holman

Podcast Transcript

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John Horton: Welcome, and thank you for joining us for this episode of the Health Essentials Podcast. My name is John Horton, and I'm your host. Today, we're talking about growing pains in children with Dr. Lainie Holman, a specialist in pediatric physical medicine.

By some estimates, almost half of all kids experience growing pains during childhood. It can be very intense pain, too. The kind that wakes up kids in the middle of the night with screams worthy of a horror flick. And what makes it even more bizarre is that the pain usually vanishes as quickly as it appears. Odds are your kid will be running around the next morning like nothing ever happened. So what exactly are these growing pains and can they be prevented? That's what Dr. Holman is here to chat with us about. Thanks for joining us, Dr. Holman.

Dr. Lainie Holman: Hi, I'm happy to be here. Thanks for having me.

John Horton: Well, thank you. Before we get into the topic, let's start by having you tell us a little bit about the clinical work you do here at Cleveland Clinic.

Dr. Lainie Holman: I practice pediatric physical medicine and rehabilitation, also known as physiatry. I basically take care of children who have functional disabilities of various kinds. I'm also a board certified pediatrician and take care of children who don't have disabilities, on occasion.

John Horton: It sounds like that's got to keep you pretty busy, I'd imagine.

Dr. Lainie Holman: It does. I'm the chair of the department.

John Horton: Then you're definitely busy. Well, that's great. Thanks for giving us that information. So now, let's turn our attention to growing pains. For starters, I mean, what are they really? And, I mean, I've read in some places where the term itself is even a little bit misleading.

Dr. Lainie Holman: Yeah. We don't really know what they are. They are pains that are mostly bilateral, mostly in the legs, that occur mostly in the evening, mostly in children between 3 and 12, but those are all really very broad. And most people don't report the growing pains. And when they do, we don't have really a clear database for statistics or epidemiology.

I was reviewing the literature this morning actually, and noted that there was a paper published in Pediatrics in July this week that was a meta review of 145 studies in eight, I believe, databases. And found just a lot of inconsistency on how we report and the associated factors.

John Horton: So Dr. Holman, if growing pains are ... I mean, it's not the ideal term, it sounds like for this. Where did that originate from in the first place?

Dr. Lainie Holman: It seems to have originated from a French text called, Maladies of Growth, that was written in 1823 by someone whose last name was Duchamp, but we don't know their first name. And it just followed children into the present day. No one seems to know really what causes it, it doesn't seem to be associated with growing. In fact, there have been a couple of small studies looking at growing pains against height velocity, and it doesn't seem to be associated at all with growing, in fact.

John Horton: Well, I'd imagine it's one of those things, because it is so common, I'm guessing a lot of parents just deal with it and see it. And it's not the sort of thing where you call your pediatrician, I mean, the next day to report it. Is that where some of the variations is, where you don't quite know how much it happens?

Dr. Lainie Holman: I think that's right. I think parents deal with it at home, especially when it's mild. And when it goes away, almost all of them are recurrent, but short-lived. And so I think parents just don't think to call their pediatrician in particular. And when they do see the pediatrician, often, because we don't know what it is and there's no specific treatment, the pediatrician wouldn't necessarily note it in the record.

John Horton: Yeah. Yeah. Now, you said the most common ages it usually starts, I mean, it can start as young as, I think you said 3 years old?

Dr. Lainie Holman: Yeah.

John Horton: OK. And then it goes, it sounds like from 3 to about 12, so that preteen time. Is there a reason as to why, I mean, maybe it's just that age group that it might hit?

Dr. Lainie Holman: We don't know the answer to that, either. The term “growing pains” is because that's the fastest period of growth velocity or height velocity in humans. And so that's associated with growing because that's the time when people are growing, but it doesn't necessarily have anything to do with actual growth.

John Horton: It's a great name though. I think that's probably better than the more scientific name you'd have with it.

Dr. Lainie Holman: There are a lot of people who are asking to call it something else, like benign leg pain of childhood. But growing pains has been around for a long time and has just stuck.

John Horton: “Benign leg pain of childhood” does not roll off the tongue quite as well as “growing pains,” for sure.

Dr. Lainie Holman: It doesn't. It doesn't.

John Horton: Is it something ... let's talk about where it's more common. I mean, is it something where, do boys or girls get it more? Is it more common in one than the other?

Dr. Lainie Holman: Again, we don't have a great database, but it doesn't seem to have a prevalence in boys or girls in particular. It seems to be mostly regional. Most kids experience it, like I said, in the legs. There are some kids who will talk about pain in their back or their chest. Some kids have complained of jaw pain, but it's pretty unusual. It's almost always both legs.

John Horton: Yeah. Yeah. I was going to ask you that. With some of that, where it hits the most? Because I think legs are the most common thing. And is that more in your calves, like those cramps that just nail you in the middle of the night? Or is it higher up in the leg, or where is it most often?

Dr. Lainie Holman: Most of the time, the location is pretty vague, which is one of the ways that we decide that it's benign, in fact. Most little kids can't describe a muscle cramp. The best I've gotten out of children I've treated have been the words “ache” or just pain.

John Horton: Yeah. Yeah. So you said the legs are by far the most common, what happens when they have it, like in their chest or something? Because I would imagine that's terrifying if you're a parent and you come in and your child's complaining about chest pain. That's just not something you think you're going to have to deal with. How does that usually come across?

Dr. Lainie Holman: I think usually the children say, “I have chest pain, my chest hurts,” which is alarming to families, for sure. But cardiac issues in children don't usually present with chest pain the way they do in adults. So it's another way that we can decide that it's benign.

John Horton: Yeah. Yeah. And then you said, I mean, it's something that can be all over. I mean, you can get it in your arms, in your hands. I mean, is it even like, headaches and things like that are common with them?

Dr. Lainie Holman: Sometimes, children will complain of a headache, but most of the time they're not able to identify head pain. It's almost always the legs, but it can be all over. When children have all over body pain that doesn't go away, that's usually a different syndrome.

John Horton: OK. All right. One of the things, I know when I was reading up on this, they said that it's typically more common in kids if they've had a really active day. If they've been outside running all day, you might see it a little bit more. I mean, is that a common occurrence, and why would that be?

Dr. Lainie Holman: We don't know the answer to that, but ... the answer to why. But it does commonly occur in the evening after an active day. And that lends credence to the theory that there is some musculoskeletal or muscle fatigue underlying the pain, but we don't really know that in terms of science.

John Horton: OK. All right. Are there any other symptoms aside from just that pain? I mean, do you ever see fevers with it or chills? I mean, anything else that comes along with growing pains or is it just pain?

Dr. Lainie Holman: No. In fact, it's just pain. And by definition, it's episodic, so it self-resolves. But recurrent, so it may happen again. But if there are fevers or rashes or chills or weight loss, or some other systemic symptoms, that needs to be seen by a pediatrician.

John Horton: Well, and that takes us right into the next question I was going to ask you, which is if you're a parent and your kid wakes up screaming like that ... and I had three kids and all of them had growing pains at one point. And there is nothing that gets you out of bed faster than that sort of scream, because it hits a decibel level that just is going to grab your attention. And it's scary. So your head instantly goes to, ‘This is something really bad.” I mean, are there other things that you should maybe worry about with it or have somebody look at it if it gets to a certain point?

Dr. Lainie Holman: Certainly, pain in the middle of the night is scary. Everything is worse in the middle of the night, it seems like with children, doesn't it?

John Horton: It does.

Dr. Lainie Holman: But usually, you can try Tylenol® or a warm bath or stretching, and some gentle, comforting distraction. And if the pain goes away, there's not necessarily anything to worry about. But pain that is persistent, pain that is very focal, meaning it's just in one particular place, or pain that comes with those symptoms we talked about earlier, definitely needs to be looked at.

John Horton: Yeah, yeah. You had mentioned massaging it or doing whatever. Is that just, you find out where it hurts, and then just give it a rub for a few minutes just to ease them muscles?

Dr. Lainie Holman: Yeah. Just a stretch. Some comforting touch is really, probably, mostly what it is. Some kids with growing pains like a little bit of pressure. So the act of massaging is comforting to them.

John Horton: Yeah. Yeah. What other home treatment options ... let's, I guess go through some of them. You had mentioned a few, but let's just narrow it down a little more. You had said it's OK to do, I see children's Tylenol, or some sort of pain reliever?

Dr. Lainie Holman: Yeah. I think that's fine. And in children who can't take Tylenol, they can take ibuprofen. Whatever parents have in the appropriate dose is fine. And then I think, like I said, warm bath, some stretching, some reassurance, some distraction, usually the pain will go away. It's often very brief, but alarming.

John Horton: Yeah. Yeah. I was going to say, how long should it last? And I know that's one of those really open-ended questions because it probably depends on the child. But is it really the sort of thing where, within a few minutes, it should be gone, like five, 10 minutes?

Dr. Lainie Holman: Yeah. Usually the episodes only last about five or 10 minutes. Often, by the time you have your measures in place, by the time you run a bath, for example, the pain is gone.

John Horton: That would be ... I mean, I can see where a bath would do it. Just, is it the warm water just relaxes the muscles a little bit?

Dr. Lainie Holman: Yes. And it's also a little distracting from the pain.

John Horton: Well that's ... anytime you can make them look the other way for a little bit or focus on something else … that's always a good thing.

Dr. Lainie Holman: It's distracting for the parent as well.

John Horton: And the warm bath brings up, I guess, an idea. I mean, are there preventative steps you can take? I mean, if your child's prone to having growing pains, I mean, is that something where if you do a warm bath before bed, that it might help alleviate it later on?

Dr. Lainie Holman: Yeah. There certainly are people who feel like their children's growing pains are better with a warm bath at night before bed, for sure. Some people feel like stretching before physical activity is useful. We don't always ask children to stretch before they play sports or before they play, but sometimes that can help. Sometimes, it can't, we don't know the exact mechanism for that. But certainly, some kids feel better with some stretching before activity.

John Horton: Yeah. Kids definitely do not stretch much. I know the older you get, the more you feel like you have to limber up before you go do about anything. So when you're 10, you're not thinking that way. What other things can you do at night before they go to bed just to maybe help it not happen?

Dr. Lainie Holman: I think just having a calm nighttime routine is good for any children, growing pains or not. But having a consistent, quiet, comforting routine at night is always really helpful. There is some, perhaps, component of anxiety in growing pains. And so you want your child to go to bed happy and comfortable and relaxed.

John Horton: Yeah. Yeah. Now, and this is the question I'm sure every parent would want an answer to, and I fear that it's not going to be the answer that they want. But it's, I mean, can you do anything to prevent growing pains from happening?

Dr. Lainie Holman: Not that we know of.

John Horton: It just, it's one of those realities of ...

Dr. Lainie Holman: Part of childhood for somewhere between 3% and 50% of children.

John Horton: Wow. Well, so it sounds like it is fairly common. When ... maybe we touched on this a little bit … but when should it get to the point where you go, “Man, I need to call the pediatrician”? Is it if you start having it multiple days in a row, if it's more than just sporadic? When should you go and seek, I guess more professional advice on it?

Dr. Lainie Holman: Yeah. I think it's reasonable to call the pediatrician when you're having several nights in a row of it, or again, when the pain is very focal. Most kids are vague about where the pain is located, but if someone clearly says ... points to a place on their leg and says, this particular place hurts. That needs to be investigated. And again, if it comes with fevers or unexplained rashes or any kind of weight change, mood changes, trouble in school, those sorts of things, loss of appetite … those sorts of things need to be investigated by your pediatrician.

John Horton: Yeah. Yeah. And this just came up, an idea in my head. When you do have the pain, do kids usually get it in the same spot repeatedly or does it migrate around the body? You might get it in the legs one day, the chest another day? What's typical there?

Dr. Lainie Holman: In my experience, most children have basically the same sites of pain, basically the same complaints. So I haven't really met very many kids who have leg pain and then chest pain and then back pain. That probably should be seen by a pediatrician as well. But most of the time, it's just both legs. One leg and then the other leg another night, et cetera. And it's usually pretty consistent. And again, not usually focused.

John Horton: Yeah. Yeah. It sounds like the one thing I'm taking out of all this is that growing pains are very normal. And for the most part, I mean, parents should not worry when they do happen.

Dr. Lainie Holman: No, they should not. As long as, again, they go away and they're not very specific and don't have any other symptoms. There are musculoskeletal conditions in children that need to be investigated, but they're very rare, and they're almost always persistent and not recurrent.

John Horton: Well, Dr. Holman, we've covered a lot of ground here today. So as we bring this conversation to a close, what other advice could you toss out there or other guidance might you have for any parents with kids who are dealing with this?

Dr. Lainie Holman: Just that some kids experience episodic pains, and we don't really know very much about what causes them or how to make them go away. And as long as they're not interfering with the child's function, that is to say, school or sports or work around the house, then there isn't any reason to be alarmed by them.

John Horton: I think they always are looking for something to get in the way of chores around the house, if my memory's right. Dr. Holman, thank you so much for being with us today and speaking with us on this helpful topic.

Dr. Lainie Holman: Sure. It was great to be here. Thanks for having me.

John Horton: If you have concerns about growing pains with your child, talk to your pediatrician, or call 216.444.4998 for an appointment. You can also find more information on children's health at clevelandclinicchildrens.org. Thank you so much for being with us today. Bye-bye.

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