Editors

PekkaLahdenne

Innocent Limb Aches ("Growing Pains") in Children

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.

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.
The prevalence is highest among children between 3 and 8 years of age. Up to one third of 4-6 years old children have growing pains Prevalence of Growing Pains in Children 4 to 6 Years of Age.
Familial occurrence is common.

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.

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.

Clinical examination Articular Status of a Child with Arthritic Symptoms to rule out other diseases and explaining the nature of the symptoms to the parents is necessary.
Self-care by massage, stretching, heat etc. is often all that is required.
Paracetamol 15 mg/kg as a single dose can be used temporarily.

Pavone V, Vescio A, Valenti F, et al. Growing pains: What do we know about etiology? A systematic review. World J Orthop 2019;10(4):192-205 [PubMed]
Lowe RM, Hashkes PJ. Growing pains: a noninflammatory pain syndrome of early childhood. Nat Clin Pract Rheumatol 2008 Oct;4(10):542-9. [PubMed]
Viswanathan V, Khubchandani RP. Joint hypermobility and growing pains in school children. Clin Exp Rheumatol 2008 Sep-Oct;26(5):962-6. [PubMed]