From the Guidelines
Growing pains are benign muscle aches or cramps that affect children, particularly in the legs, and are not related to growth spurts, as suggested by the American Academy of Sleep Medicine in their 2025 clinical practice guideline 1. These pains typically occur in both legs, especially in the front of the thighs, calves, or behind the knees, and tend to appear in the late afternoon or evening, sometimes waking a child from sleep. Some key characteristics of growing pains include:
- They usually last for 10 to 30 minutes
- Can be relieved with gentle massage, stretching, warm compresses, or over-the-counter pain relievers like acetaminophen or ibuprofen at age-appropriate doses
- Are diagnosed clinically after ruling out other conditions, such as restless legs syndrome (RLS) or periodic limb movement disorder (PLMD), which can present with similar symptoms 1
- Do not cause limping, fever, or joint swelling The exact cause of growing pains remains unknown, but theories include muscle fatigue from physical activity, anatomical factors like flat feet, or decreased pain threshold. It is essential to differentiate growing pains from other conditions that may mimic their symptoms, such as RLS, which is characterized by an urge to move the legs when immobile, often associated with dysesthesias in the affected extremities 1. In clinical practice, a careful history is crucial in making an accurate diagnosis, as there is no objective test to aid in diagnosing growing pains or RLS 1.
From the Research
Definition and Characteristics of Growing Pains
- Growing pains are a common, benign syndrome of recurrent discomfort that occurs in young children, typically characterized by bilateral pain in the lower extremities that occurs late in the day or at night 2, 3, 4.
- The peak incidence of growing pains does not correspond to a time of rapid growth, and the exact cause remains unclear 2, 4.
- Growing pains are generally self-resolving and do not cause long-term harm, but they can be a source of distress for children and their families 2, 3, 4.
Diagnosis of Growing Pains
- Diagnosis of growing pains requires a thorough patient history and physical examination to rule out other possible causes of pain 2, 3, 4.
- Clinical cautionary signs, such as unilateral pain, morning stiffness, joint swelling, and systemic symptoms, should trigger an extended evaluation to exclude other more serious conditions 3, 4.
- Laboratory and radiographic evaluation are not typically needed to make the diagnosis of growing pains, unless there are atypical symptoms or physical examination abnormalities 4.
Management and Treatment of Growing Pains
- Management of growing pains generally consists of symptomatic care with massage, over-the-counter analgesics, and reassurance to children and parents about the benign, self-limited nature of this condition 2, 3, 4.
- Mild pain medications can be employed in more severely affected patients, but it is essential to inform family members about the benign nature of the condition and provide reassurance 2.
- Physical relaxation exercises, massaging, and stretching of the leg muscles can also help reduce pain without medication 2.