Chronic Pain & Growing pains

Non-specific musculoskeletal aches and pains are common in children, and the differential diagnosis is broad. Careful clinical assessment is essential, with exclusion of red flag features before considering benign causes.

Hypermobility is common in childhood and a feature of normal development; however, not all aches and pains should be attributed to hypermobility, as many hypermobile children are entirely asymptomatic. Other causes of musculoskeletal pain include inflammatory joint or muscle disease and metabolic conditions such as osteomalacia or thyroid disease.

Chronic idiopathic pain syndromes (CRPS)

Chronic idiopathic pain syndromes, also referred to as Chronic Regional Pain Syndromes (CRPS), are most often seen in older children and adolescent girls. Pain can be severe and functionally limiting, although the child is otherwise well and examination findings are often minimal.

The localised form most commonly affects the hand or foot, may follow a minor injury, and can present with characteristic features such as coolness, colour change (cyanosis) and marked sensitivity to touch. The widespread form may be associated with fatigue and general debility.

These children may become significantly disabled and miss school, and management requires a multidisciplinary approach, including physiotherapy, pain management and psychological support. Outcomes vary, but early recognition and coordinated care improve recovery.

Growing pains

“Growing pains” are a benign condition of childhood and are not related to growth. The cause is unknown.

They typically occur in younger children, presenting as aching in the lower legs, particularly the calves, feet and ankles, often after activity and most commonly in the evening or at night, sometimes waking the child from sleep.

It is important to ensure that serious pathology such as arthritis or malignancy is not missed, and growing pains should only be considered once other causes have been excluded.

Management focuses on explanation and reassurance. Practical advice includes the use of simple analgesia such as paracetamol before bedtime, massage of the affected limbs, and the use of supportive footwear (e.g. trainers or sports shoes), which may reduce the frequency of symptoms. Parents should also be advised when to seek further medical review, particularly if symptoms change, become persistent, or are associated with systemic features.