Growing pains are a bit of a mystery to parents and physicians alike. Do any search on the internet and you’ll find yourself entrenched in websites and blogs with parents asking, “Are growing pains real?” Children in general don’t report pain without some sort of injury. When they do, many parents ask themselves (and me), “Could my child have growing pains?” It’s important for parents and practitioners alike to understand the symptoms, treatment and when to search further for other causes of pain.
What are the symptoms of growing pains?
While the exact cause of this syndrome (also called Benign Nocturnal limb pain of childhood) is poorly understood, the pattern of symptoms and pain is a bit clearer. Most children report the following:
- Pain involving both legs (rarely seen only on one side or in the arms)
- Pain more commonly in the muscles, not the joints
- Symptoms last 30 minutes or less, can occur for hours in rare cases
- Pain at night or early evening
- Can awaken child from sleep
- Typically seen in kids between ages of 3-12
There are no specific qualities in children that would lead them to develop these symptoms. It occurs in boys and girls equally. No links have been found for family history of similar problems, weight, height, ethnicity, etc. Additionally, despite the name they are given, there is no clear association between growth spurts and development of pain.
What causes growing pains?
As mentioned earlier, the exact reason as to why pain develops is poorly understood. When the condition was first described in the 1930s and 1940s, it was believed due to faster bone growth compared to the attached muscles and tendons. However, the largest growth spurts occur later in adolescence, so this initial theory is not supported well. Other theories have been considered over the years:
- Bones are covered by a thin layer of tissue, called the periosteum. When bones grow in length, occasionally this outer layer will not grow as fast as the bone, causing stretching of the tissue and severe pain episodes.
- Some research has found that children who experience growing pains have decreased bone strength compared to kids without pain. After a day with high levels of activity, pain may occur due to increased stress forces through weakened bones
- Some children with this condition have increased mobility and flexibility in the joints, developing flat feet. This can lead to imbalance of stress through the legs, causing pain.
- Other proposed theories include decreased blood flow to the bones, having a lower pain threshold, underlying emotional distress, etc.
How are growing pains diagnosed?
Some of the most common questions I get from parents is “How do you test for growing pains?” and “When should I be concerned the pain is something else?” Parents are always concerned that the pain could indicate another problem and wish to be careful about dismissing complaints, just calling it “growing pains”. First, always seek the advice of a pediatrician to evaluate for the cause of pain. A diagnosis of growing pains is given when children report a typical symptom pattern and no abnormalities are found on physical exam. There is no specific lab test or x-ray finding that is used to diagnose growing pains; however, your physician may order labs or an x-ray to rule out other causes of pain. Moreover, if any of the following symptoms occur, other conditions should be considered:
- Pain that frequently occurs only in one leg
- Pain or stiffness that persists in the morning
- Redness or swelling over the painful area
- Tenderness that occurs with touching the painful site
- Limping or weakness that occurs in the affected leg
- Fever or rash occurring in conjunction with the pain
How is it treated?
One of the most important points for parents to remember when helping their children with growing pains is that this is a benign condition. This is not an issue that causes long term pain or puts kids at risk for problems in the future; in fact, most cases completely resolve by early adolescence. Always consult with your pediatrician prior to initiating any treatment. Here are a few ideas for conservative treatment:
- Gently massage the painful areas in the legs (either your child or yourself should do this)
- Soak the legs in a hot bath at night
- Use medications for inflammation, such as Tylenol/paracetamol or ibuprofen on an as needed basis for pain relief. Consult with your physician prior to giving medication
- In severe cases with almost daily pain episodes, use of a long-acting pain medication may be required
- If flat feet are found, use of a shoe insert with good arch support may reduce pain
Lastly, reassure your child. Kids look to parents for guidance and can sense when you are nervous, anxious or very tense over the pain. If you remain calm and reassuring, your child will manage and get through the pain with more ease.