Diagnosis and Treatment of Growing Pains in Children

Growing pains are a common childhood experience, occurring in up to one third of children between 4 and 14 years of age. The term "growing pains" refers to deep limb pain, usually in the lower legs. Growings pains can be quite severe and typically occur only at night with full resolution of the pain by morning.

Despite over 200 years of documentation on growing pains in children, the exact cause of these pains remains unknown. It is postulated that many factors may contribute. These include joint hyper-mobility and flat feet, decreased pain thresholds, reduced bone strength, and emotional factors involving the patient's family and other social stressors.

The diagnosis of growing pains is one of exclusion. Other common causes and uncommon but potentially debilitating causes of limb pain in children must be excluded before a physician can reach the diagnosis of simple growing pains.

Several clues point toward a diagnosis of growing pains. These include:

1. Pain occurs during the night and disappears by morning.

2. Pain occurs in both limbs at the same time.

3. Pain is not associated with the joints.

4. Pain is not caused by walking and does not cause a limp while walking.

5. Pain is not associated with any tenderness to the touch, redness or local swelling.

6. Pain occurs in the absence of systemic signs or symptoms of disease, such as fevers, weight loss, easy bruising or bleeding, or night sweats.

If limb pain in a child meets all of the above criteria, a diagnosis of "growing pains" can be made without radiographic imaging or lab tests. If all these criteria are not met further work up may be necessary to rule out other causes of limb pain which can include:

-malignancies

-rheumatologic disorders

-infection

-trauma (both accidental and non-accidental)

-congenital abnormalities

-other pain syndromes

The management of growing pains usually includes the application of heat, massaging the area, and regular basic stretching of the affected muscles. If the child has flat feet shoe inserts may be helpful. A child with hyper-mobility may benefit from physical therapy.

In most cases, the condition is self-limited and will resolve without specific intervention. Ibuprofen provides pain relief in most children. If children have difficulty sleeping through the night, then a longer acting analgesic such as Naproxen may be used.

Please refer to the article below for detailed information and an excellent review of growing pains.

References:

Lowe, Robert M RM. Growing pains: a noninflammatory pain syndrome of early childhood. Nature clinical practice Rheumatology. Issue 10. Oct 2008.