Every parent has been there—it’s 2 a.m., and their kid wakes up crying with a tight grip on the shins, complaints of pain, no fever, no apparant injuries or other discernible abnormalities. Growing pains in children are among the most common reasons pediatric parents get shuttling all over the clock with their kids, but the condition is surprisingly complex. Many parents don’t know whether to be alarmed, rest, or seek out medical attention.
Understanding Growing Pains in Children Symptoms
The timing of the experience seems to run along a predictable pattern which is a relief to be aware of once parents know what to look for. The most commonly diagnosed age ranges are 3-12 years and two key time frames emerge: toddlerhood to five years and between 8-12 years. It most commonly occurs late in the afternoon/early evening and may wake children from sleep, but it is usually gone by morning.
Common Signs and Symptom Pattern
The pain is commonly described as ‘aching’ or ‘throbbing’, involving predominantly the thighs, calves or behind the knees. Both legs are affected, not just one side and in children are often able to target a site in a general area rather than one discrete site, which is important to remember. The attacks can last for minutes or hours and do not interfere with the child’s participation in physical activity the following day, which is another vital point – a child who is running around and playing normally during the day while crying at night is demonstrating a classic presentation.
What Is Not Typical
Any features that would be a worry. Not swelling, red, hot, or any visible changes around the joint. Limping during the day time, continuous pain in the same precise area every time, morning pain, including any associated fever points to infection or inflammation rather than benign muscle pain.
Day time pain limiting activity or pain so bad the child won’t weight bear falls outside what should be expected. 10 These are not reasons to ring the alarm bells just yet, but they are reasons to seek advice as soon as possible.
Why Growing Pains Happen
Truth is – the name is actually a misnomer. Contrary to popular belief, the pain of growing pains is not directly related to the fact that the child’s bones are growing. Bone growth itself does not lead to pain; in fact, the skeleton is growing almost constantly, very slowly, and without producing the episodic episodes that these kids get at night.
So what is going on?
Growth Spurts vs. True Cause
Honest answer: no one really knows. Several early theories involved stretching or rapid growth of the bones, and although these have gained some popular support, studies have shown no relation between growth rate and presence/absence of symptoms. The more commonly-accepted diagnosis today, is that the pain is caused in the muscles – that physical activity during the day causes the muscles to become fatigued in the active child’s body.
At this age children are running and jumping and climbing and generally wearing out muscles at a level that could be exerting to most grownups.
Possible Risk Factors and Triggers
There are various factors which appear to make one more prone to these. Children with joint hypermobility – where the joints move through a greater range of movement than is usual – seem to get them more often. Also children with flat feet are affected, as this could affect the forces acting through the leg during activity.
Long days of activity, for example an after school sports fixture, or a very busy day at school, have also been reported more in advance of an attack. There has also been some reported link to a lower threshold for pain in some children, and ‘ emotional tension’ has been proposed as increasing sensation, although this has not yet been fully researched.
How Doctors Diagnose Growing Pains in Children
To diagnose it there is no specific test. The diagnosis is what clinicians call a ‘diagnosis of exclusion’ that is, the doctor rules out other possible diagnoses before deciding that benign growing pains are to blame. That sounds more systematic than it actually is:
Questions Doctors Ask
The paediatrician will ask about the pattern, duration and character of the pain in great detail – inclusive of whether both legs are affected, whether the pattern is nocturnal or diurnal, how long episodes last, whether the children is entirely back to normal by morning. Ask about activity levels – what the child was doing that day and whether it was a particularly physical activity. Ask if sleep is affected, whether the pain has ever resulted in a limp, or an inability to walk.
Can all this be answered in advance of the consultation?
Yes.
When Tests or Imaging May Be Needed
Laboratory testing is not necessary when the symptom pattern is simple and unchanging and the physical exam is normal. However, tests such as blood work to rule out systemic, infectious, or inflammatory causes of the presentation (e.g. raised inflammatory markers) or radiographic imaging of the bones and joints (e.g. MRI, X-ray) may be ordered by a pediatrician when the presentation doesn’t follow the expected course (e.g. pain is always unilateral, the child has fatigue, anosmia, unexplained weight loss, persistent fevers).
Best Ways to Relieve Growing Pains at Home
Practical comfort measures do work, and most parents say that if a different approach is tried each time, this makes nighttime disruptions easier to manage.
Heat, Massage, and Stretching
In some cases, placing a warm heating pad or warm towel over the legs can relieve muscle tightness fairly rapidly. Gentle massage—using the hands to manipulate along the length of the thighs and calves—can often relax the aching within minutes, allowing children to calm down and sleep as usual. Repeating stretching of the quadriceps and calf muscle group throughout the day may, over time, decrease the number of episodes—particularly in very physical children.
Pain Medicine and Activity Habits
Over the counter choices such as acetaminophen or Ibuprofen can be used in increased severity of episodes, once again according to age appropriate dosing. Ibuprofen is a good choice for muscle pain because it is anti-inflammatory. It is not always necessary to have medication, however, massage and heat can work quite effectively for pain management.
In some cases, monitoring activity level on more intense days, sleeping well and maintaining sleep schedules, and this can also decrease frequency of episodes.
When to Call a Doctor
Being aware of the right time to consult a professional helps from being over worried or left too late with something more serious.
Red Flags That Need Medical Attention
Any ongoing pain that does not come and go in a typical pattern of evening and then disappearing should be assessed. The same is true of any pain where there is swelling, redness of the joint, fever or significant limp. Also unexplainable tiredness, poor appetite or weight loss in conjunction with leg pain can sometimes be due to conditions such as juvenile arthritis or rarely others and this should not be ignored.
How Parents Can Track Symptoms
All that is needed to provide a pediatrician with truly valuable information is a basic log of when the pain occurs, what leg or legs are involved, what was the child’s recent activity and how long does each episode last. Many a pattern is detected within the first week or two.