Growing Pains in Children and Teens: When Is It Normal and When Is It Not?

What Growing Pains Are

Growing pains are described as the most common form of episodic childhood musculoskeletal pain. The usual picture is intermittently recurring pain in the legs that comes on in the evening or at night, sometimes waking the child from sleep. The condition is considered benign, although it can be distressing for children and parents (Uziel & Hashkes, 2007; Arikka, 2010).

The name is misleading. Despite it, the pain is not clearly associated with the child's growth, and the cause remains unknown.

How Common They Are

A survey of parents of children aged 4 to 6 years in South Australia estimated the prevalence of recurrent leg pain described as growing pains at 36.9% (Evans & Scutter, 2004). Other studies have reported widely varying figures, partly because definitions differ. What matters clinically is that doctors identify growing pains from a typical pattern of symptoms together with a normal physical examination, and only when clear clinical criteria are met (Uziel & Hashkes, 2007).

When the Picture Is Not Typical

Because growing pains are recognised by their pattern, features outside that pattern deserve medical review. These include pain that is persistent or present during the day, pain limited to one spot or one side, a limp or reluctance to walk, joint swelling, redness or warmth, morning stiffness, fever, unexplained tiredness, weight loss or a rash, pain following an injury, and back pain in a young child. None of these means something serious is present, but they are reasons to see a GP or paediatrician before any musculoskeletal treatment, as other causes need to be considered (Arikka, 2010).

Pain that is tied to activity and located at a specific growth site is a different matter. In older children and teens, localised pain at the front of the knee or the back of the heel after sport is more often related to growth plate irritation, such as Osgood-Schlatter disease, and is managed through load adjustment rather than reassurance alone.

Supporting a Child With Growing Pains

Reviews describe the management of growing pains and a generally good outcome in nearly all children (Uziel & Hashkes, 2007), and education and reassurance for the child and parents are central to usual care. Comfort measures such as warmth and gentle massage by a parent are commonly used, but a review of the literature found it largely consisting of opinion, with very little trial evidence for specific treatments (Evans, 2008). Identifying the cause of a child's pain and managing it over time should involve a medical practitioner, with musculoskeletal assessment helping to separate growth-related load problems from the typical benign pattern.