Growing Pains

Ovid: 5-Minute Orthopaedic Consult

Editors: Frassica, Frank J.; Sponseller, Paul D.; Wilckens, John H.
Title: 5-Minute Orthopaedic Consult, 2nd Edition
> Table of Contents > Growing Pains

Growing Pains
Paul D. Sponseller MD
  • This poorly understood syndrome is
    characterized by a long history of lower extremity pains that usually
    occur at night and worsen after active days.
  • Pain:
    • Resolves completely each time it occurs
    • Occurs predominantly in the lower extremities
    • Occurs in 1 or both legs with random frequency
  • No objective physical findings are seen.
  • Synonyms: Leg aches; Night pains
  • Very common
  • An estimated 15–36% of children complain of these pains at some time (1).
  • Occurs in children 3–10 years old (1)
  • Slightly more common in girls than in boys
Risk Factors
High activity levels in normal young children
  • The condition is believed to be secondary to stretch or fatigue of muscle.
  • Support for this theory:
    • The fact that bones grow primarily when they are unloaded
    • The beneficial response that many children have to a stretching program (2,3)
Signs and Symptoms
  • Signs:
    • Nonspecific for this condition
    • No localized tenderness
    • No limp
    • Full ROM
  • Symptoms:
    • Pains occur after periods of activity, most often at night.
    • Pains come and go spontaneously.
    • Pains most often are bilateral, vague, and poorly localized.
    • Symptoms are often of long, though intermittent, duration, a feature that helps to rule out more serious causes.
Physical Exam
  • Usually, with a careful history and physical examination, one can rule out more serious causes and define a typical picture.
  • The child should be observed while
    walking into the office, especially before the child knows that the
    examiner is watching; there should not be any stiffness or limp.
  • The lower extremities should be palpated systematically for tenderness; growing pains do not manifest tenderness.
  • The ROM of the hips, knees, and ankles should be checked.
    • The hips, in particular, should show no stiffness or guarding on gentle rolling (the “roll test”).
    • ROM should be full and symmetric.
  • If the history is not typical:
    • Complete blood count and ESR may be done.
    • An appropriate workup tailored to the possibilities listed in the differential diagnosis should then be undertaken.
  • Bone scans and plain radiographs may help to define the site of pain if the history is not typical.
  • However, these tests are not needed in most cases.
Differential Diagnosis
  • Perthes disease
  • Chronic or subacute osteomyelitis
  • Leukemia
  • Sickle cell anemia
  • Juvenile rheumatoid arthritis
  • Lyme disease
  • OSD (older child)
  • Restless leg syndrome (4)
General Measures
  • If the diagnosis of growing pains fits the history, reassuring the parent and child is the 1st step.
  • A program of stretching for the
    hamstrings, quadriceps, and calf muscles at night before bed has been
    shown to decrease the number of complaints, perhaps by mechanical means
    or by virtue of increased parent–child interaction.
  • Activity levels may need to be modified to bring symptoms into a tolerable range.


Special Therapy
Physical Therapy
The stretching program described under “General Measures” may be guided by parents and does not require a trained therapist.
Analgesics may be used periodically, but not continuously.
Spontaneous resolution is the rule as the patient matures.
Patient Monitoring
  • Several successive office visits may be needed to show the character of the pain or to determine the direction of the workup.
  • The stretching program is maintained, and the activity level is adjusted as needed.
1. Evans AM, Scutter SD. Prevalence of “growing pains” in young children. J Pediatr 2004;145:255–258.
2. Baxter MP, Dulberg C. “Growing pains” in childhood—a proposal for treatment. J Pediatr Orthop 1988;8:402–406.
3. Noonan
KJ, Farnum CE, Leiferman EM, et al. Growing pains: are they due to
increased growth during recumbency AS documented in a lamb model? J Pediatr Orthop 2004;24:726–731.
4. Rajaram SS, Walters AS, England SJ, et al. Some children with growing pains may actually have restless legs syndrome. Sleep 2004;27:767–773.
729.5 Growing pains
Patient Teaching
  • Describe the nature of the process.
  • Instruct in stretching exercises.
  • Offer to see the patient any time the symptoms change.
Q: Is growing pains a real condition?
Although the pathogenetic mechanism is lacking, most specialists agree
that a constellation of symptoms, with a history of spontaneous
resolution, is seen frequently by pediatricians and orthopaedic
surgeons everywhere.
Q: Is physical therapy necessary?
A: It is better to maximize parent–child interaction by stretching.

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