Diseases & Conditions
Relatively severe pain in the legs and behind the knee that occur in elementary school children, often after a strenuous day of activity. Growing pains occur at night while a child is in bed but always pass in time and should never be a cause for concern. Most experts believe there is little connection between the pain and growth spurts except for the fact that they usually occur during a period of rapid growth.
Growing pains generally strike at two periods during early childhood: among three to ﬁve year olds, and again in eight to 12 year olds. Growing pains typically affect about a quarter of all children, and although the pains are not serious, they can be upsetting to a child. Growing pains do not mean that a child is too active or doing anything wrong. Perfectly healthy children have these pains, which occur slightly more often in girls.
No ﬁrm evidence exists to show that growth of bones causes pain, and so a child is not actually feeling the bones grow. Instead, the pain is probably due to the strain caused by vigorous daytime activities on growing muscles and bones. These pains should disappear by the time she is a teenager. The pains can occur after a child has had a particularly athletic day.
Although growing pains often strike in late afternoon or early evening before bed, there are occasions when pain can wake a slumbering child. The intensity of the pain varies from child to child, and most kids do not experience the pains every day.
Growing pains usually last for 30 minutes to an hour as the child is going to sleep, and they always affect both sides of the body the same way. The pain is usually deep in the muscles of the calves and thighs, or sometimes behind the knees. Growing pains are often intermittent, coming once a week or even more infrequently, and always appear in the muscles rather than the joints. While joints affected by more serious diseases are swollen, red, or warm, the joints of children experiencing growing pains appear normal.
One important difference between growing pains and other diseases is that children in pain due to a serious medical disease do not like to be handled, whereas children with growing pains feel better when they are held, massaged, and cuddled.
Doctors can diagnose growing pains simply by ruling out other conditions with a thorough history and physical examination. In rare instances, blood and X-ray studies may be needed before a diagnosis of growing pains is made.
Massage, stretching, heat, acetaminophen (Tylenol), or ibuprofen (Advil) may help to relieve the pain. Support and reassurance that growing pains will pass as children grow up can help them relax.
When to Call a Doctor
Pains in the shoulders, arms, wrists, hands, ﬁngers, neck, or back, or pain associated with a particular injury, are not due to growing pains and should be evaluated by a child’s doctor. Since growing pains always affect both legs, pain in just one leg and never the other is unusual and should be seen by a physician. And since growing pains are always gone by morning, pain that is still present when the child wakes up could signal something more serious.
A doctor should be consulted if any of the following symptoms occur along with the growing pain:
• unusual rashes
• loss of appetite
• weakness and fatigue
A child should see the doctor if the pain is severe and coming from one particular spot; the doctor may want to do a bone scan to rule out a bone infection or tumor. If the child cannot put weight on a red, swollen limb and there is a fever, the child could have an infection or a fracture. A blood test will reveal any infection and an X ray will diagnose a potential fractured bone. If the child’s pain is in a joint and it cannot be easily moved, or the joint is swollen, there is a slight chance the child could have juvenile rheumatoid arthritis or an autoimmune disorder.
If the child has a great deal of pain in one hip, thigh, or knee and has trouble putting weight on that leg, the doctor may want to x-ray the thighbone to rule out Legg-Calve-Perthes disease. In this condition, the blood supply to the bottom of the thigh bone gets cut off so that the tip dies. The bone will regenerate within a few years, but the child may need bed rest or a cast to relieve pressure until the area begins to heal. Usually this disease affects boys between age four and puberty.