Growing Pains

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“Growing pains” are a commonly used term for aches and pains in children. It is a commonly misused diagnosis for musculoskeletal pain in growing children and true growing pains are not related to growth. “Leg Aches” has been proposed as a term to replace growing pains due to confusion in the literature and the dismissing by some health professionals of leg aches as being just ‘growing pains’. The differential diagnosis includes potentially very serious conditions

True syndrome of “growing pains”:
• generally peaks around ages 4 to 5 (can occur up to age 12)
• generally occurs in popliteal fossa
• usually relieved by gentle massage
• the child does not limp
• only occurs at night (growing pains do not occur during day)
• benign and self limiting – treatment not usually needed.
• systemically they are no unwell
• May occur in up to 15-30% of children

Intense cramping pain behind knee, in deep musculature of posterior leg or anterior thigh – usually poorly localised; usually lasts up to 20 minutes, later in the day and may wake child from sleep; does not alter gait; no point tenderness on palpation; usually bilateral; does not limit activities the following day. As part of differential, Check for point tenderness, guarded or restricted joint motion and any signs of systemic illness.

Cause of pain is unknown – but unlikely to be solely related to ‘growth’ – other suggested (speculated) factors include muscle fatigue, overexertion, chemical imbalances and genetic factors

Differential diagnosis – bone tumours (deep aching pain that is more localised); hip dysplasia; infections (eg Brodies abscess); juvenile chronic arthritis; spinal disorders; synovitis; Perthes disease; slipped capital femoral epiphysis

Red flags: systemically unwell; limping; morning symptoms; widespread pain; abnormal developmental milestones

• Do not dismiss as growing pains; do not overlook potentially serious problems
• Reassurance of child and parents as to self limiting nature
• Stretching only treatment shown to be effective (ref)
• Massage and/or heating may help some
• NSAID’s can be tried at bedtime if waking from sleep

Growing pains do not occur in other parts of the body apart from the legs; this indicates that they must be mechanical in nature.

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