Growing pains are a common childhood complaint, affecting 10-20% of school age children, usually between ages 3-12. They are characterized by recurrent episodes of pain, typically in the legs. The pain is usually benign and self-limiting, with no long-term consequences.

 

Causes

  • Hypermobility
  • Hypovitaminosis D
  • Low pain threshold
  • Postural problem
  • Difficult temperament
  • Decreased skeletal vascular perfusion
  • Social deprivations
  • Phsysical or sexual abuse
  • Decreased fitness

 

History and examination

  • Age 3-12 years
  • Risk factors: Family history of growing pains
  • History: Pain occurring mainly in the evening or night, absence of pain during the day, no joint swelling or redness, history of vigorous physical activity
  • No history of trauma

Symptoms

  • Bilateral leg pain over calf  and thigh region; often poorly localized
  • Aching, throbbing, or cramping sensations
  • Pains relieved with analgesics such as paracetamol or a simple massage

Signs

  • No signs of inflammation, injury, or joint abnormalities
  • Normal growth and development
  • pGALS screen (i.e., pediatric gait, arms, legs, spine).

growing pain

 

Note: Presence of joint swelling or restriction could suggest a possibility of inflammatory arthritis. Hyperextensible joints would be suggestive of “benign joint hypermobility syndrome”

Pallor, bruising, organomegaly or lymphadenopathy would be red flag signs.

Differential diagnosis (D/D) & Complication

D/D:

    1. Juvenile idiopathic arthritis (JIA) (Morning stiffness, joint swelling)
    2. Infections (Fever, localized redness or warmth)
    3. Fractures (Trauma history, localized tenderness)
    4. Benign joint hypermobility syndrome
    5. Complex regional pain syndrome (CRPS)

 

Complications: Sleep disturbances, impact on daily activities

Investigation

  • No specific investigations are needed for diagnosis as it is primarily a clinical diagnosis
  • Complete blood count and peripheral blood smear
  • Acute phase reactants (ESR, CRP)  in case of red flag sign

Admission criteria

  • Not Required

Management

  • Medical:
    1. Analgesics: Paracetamol or ibuprofen for pain relief
    2. Syp CalVit 5ml PO HS x 1 Month
    3. During pain firm massage and warm compresses to relieve muscle discomfort
  • Exercise: These include simple stretching exercises involving the quadriceps, hamstrings, gastrocnemius group of muscles.

Advices

  • Reassure parents and child about the benign nature of growing pains. Usually growing pains episodes show gradual decline in frequency over a period of few years and resolve by adolescence.
  • Encourage regular physical activity and stretching exercises

Referral

  • Refer to a pediatrician if the pain persists, worsens, or is accompanied by other symptoms (e.g., fever, joint swelling)

Follow up

  • Follow up as needed, based on the child’s symptoms and response to treatment

References

  1. Evans, A. M. (2010). Growing pains: contemporary knowledge and recommended practice. Journal of Foot and Ankle Research, 1(1), 1-7.
  2. Uziel, Y., & Hashkes, P. J. (2007). Growing pains in children. Pediatric Rheumatology Online Journal, 5(1), 5.
  3. Baxter, M. P., & Dulberg, C. (1988). “Growing pains” in childhood: A proposal for treatment. The Journal of Pediatrics, 113(4), 674-677
  1. https://iapindia.org/pdf/Ch-033-STG-growing-pains.pdf