Top Tips for Growing Pains

Growing pains do exist! The cause of growing pains is unknown but not deemed to be caused by growth. The label is often used rather than the new terminology ‘benign nocturnal idiopathic pains of childhood’.

Keep to the ‘rules’ of growing pains and you can make a diagnosis.

The rules are that the typical age range is 3 to 12 years of age. Pains are invariably symmetrical, do not cause limp, are not present in the mornings or interfere with day time activities, the child is otherwise well and examination is normal (other than evidence of hypermobility). Investigations may not always be needed but if done, are normal.

Growing pains are often ‘cramp like’ aches and tend to affect the lower limbs – calves, feet most prominently. They are not limited to joints and are never present on waking in the morning.

If there are clinical concerns (e.g., the presentation does not fit the rules of growing pains), then do refer (paediatrics, paediatric rheumatology) and do not wait for the results of investigations. If the child is systemically unwell or there is delay or regression of their achieved motor milestones, then do not make a diagnosis of growing pains – the child needs referral.

Beware of red flags which are suggestive of infection, malignancy or non-accidental injury and consider inflammatory arthritis, osteomalacia, muscle disease or thyroid problems.

Night waking is very common with growing pains, often intermittent and predictable after exertion the day before or evening beforehand. The severity of the pain can be severe and distressing. Concern about night waking is needed if the child is unwell, or the night waking is every night or becoming more frequent.

The assessment of a child with suspected growing pains needs careful clinical assessment with open probing questions about concerns, development and physical examination looking for red flags and should include pGALS as a basic screen for all joints. Investigations may not always be needed but if done, are normal.

Management rests on explanation, reassurance and advice on analgesia (can be given at bedtime after busy days to prevent night waking.)

Parents need to know when to return to health care for further assessment. A parent information leaflet is available at http://www.arthritisresearchuk.org/health-professionals-and-students/reports/hands-on/hands-on-autumn-2008-information-sheet.aspx

Please note: a pdf document of these Top Tips is also available here.