Diagnosis and treatment take, as a rule, place at the primary care level.
Innocent leg aches ("growing pains") can be identified on the basis of history and the clinical presentation.
Suspect other causes of pain if the child is below 3 years of age, there is continuous pain only in one limb or if the pain makes the child limp or there are objective findings.
Epidemiology
Recurrent pain with no identifiable cause mainly in the lower limbs of growing children
Probable background factors in growing pains may include strain related to exercise during the day and/or joint hypermobility.
Shin and calf areas of the lower legs and bends of the knees are the most usual sites of the pain.
The pain is mostly symmetrical: it is felt in both lower limbs or it shifts from one limb to the other.
The pain is usually present in the evening, during bedtime, or during the night, but usually not in the morning (in contrast to arthritis causing morning stiffness).
The pain is felt during rest, but not during exercise.
The pain lasts 0.5-5 hours.
The age-related variation in the morphology of the lower limbs is not associated with the occurrence of growing pains.
Findings in clinical examination are completely normal in association with growing pains.
Another cause for the pain should be considered if the child has
limping or interruption of play or exercise because of the pain
associated symptoms (e.g. the general condition is affected)
continuous unilateral pain
symptoms in the morning or during the day.
Investigations
If the presentation is not absolutely typical, e.g. there is unilateral pain, pain in the upper extremities, morning stiffness, joint swelling or systemic symptoms (fever, weight loss, fatigue) examine at least
complete blood count (exclusion of leukaemia)
CRP, erythrocyte sedimentation rate (suspicion of arthritis).
Imaging studies (x-ray or ultrasound) are only warranted if the pain is clearly localized to one spot or if there is some objective local clinical finding.