The most common form of episodic musculoskeletal childhood pain is growing pain (GP). GPs are not dangerous and are most often described as a throbbing or aching pain in the legs.
Children between the ages of 3 – 12 years are typically affected with at least 1 - 4 in every 10 children experiencing GPs at least once. Both boys and girls are affected and these pains tend to occur at night, sometimes even waking a child from sleep.
Although they are called ‘growing pains’ there is no evidence that suggests growth actually hurts. Moreover, they do not occur during periods of rapid growth. The etiology is still unknown, however, it has been suggested that GPs are linked to restless leg syndrome in addition to several other theories. Many children with GPs have flat feet and are hypermobile (i.e. very flexible). Some children with GPs are also known to have a lower pain threshold than their peers and may have accompanying abdominal pain and headaches.
In one study it was found that children who experience GPs have lower bone strength in comparison to the unaffected population. As a result, these children may experience pain after activities such as climbing, running and jumping. This pain occurs due to overuse of the limbs and strain on the musculoskeletal system. In addition to the physical theories, it also believed that GPs may be linked to psychological issues in the child as well.
The child experiences pain mostly in the calves, shins, thighs and area behind the knees, typically bilaterally (i.e. on both sides of the body). The pain occurs in the evening and at night, and usually resolves by the morning. It is predictable, in that it occurs on a day when the child participated in increased physical activity. It usually lasts up to 30 minutes, but may be as little as 10 minutes to as much as several hours with varying degrees of intensity. While GPs are intermittent with periods that are relatively pain-free, some children may experience them daily.
Diagnosis and Management
Diagnosis is made primarily on the grounds of the typical clinical symptoms, because there are no specific laboratory tests to confirm that a child has GPs. Nonetheless, there are diagnostic tests, such as bone scans, that are useful in ruling out other pathological conditions. There is no need to do these when a child has the typical clinical findings seen with GPs but those exhibiting atypical symptoms require extensive laboratory investigations and/or imaging to identify possible underlying pathologies. Atypical findings include one-sided pain and/or stiffness or pain in the morning.
There is no specific treatment for GPs, therefore parents are encouraged to make their children more comfortable by massaging the aching areas or applying a warm heating pad to the sore muscles. Over-the-counter pain medications like ibuprofen may be useful, but overuse should be avoided. Children with flat feet may receive assistance by using shoe inserts. Parents are reminded not to worry otherwise, because GPs are not linked to any serious diseases and are completely resolved by late childhood.
Reviewed by Afsaneh Khetrapal, BSc (Hons)