Is There a Diagnosis of Growing Pains?
Yes, growing pains is a recognized clinical diagnosis, though it lacks standardized diagnostic criteria and is not caused by actual growth. Growing pains, also referred to as benign nocturnal limb pains of childhood, represents the most common cause of recurrent musculoskeletal pain in children, affecting up to one-third of the pediatric population 1, 2.
What Growing Pains Actually Are
Growing pains is an accepted medical term for a benign, self-limiting syndrome of recurrent discomfort in young children 3. Despite the name, these pains are definitively not caused by growth 3. The peak incidence does not correspond to periods of rapid growth, and the etiology remains unclear despite being described since the 1800s 4.
Clinical Characteristics
When the history is classic and physical examination is normal, no laboratory or radiographic evaluation is needed to make the diagnosis 4. The most consistent features include:
Pain Characteristics (in order of consensus):
- Lower limb pain (mentioned in 50% of medical literature) - bilateral in 86% of cases 1, 2
- Evening or nighttime occurrence (48% of sources) - nocturnal in 74% of patients 1, 2
- Episodic or recurrent course (42% of sources) 1
- Normal physical examination (35% of sources) 1
- Bilateral distribution (31% of sources) 1
Typical Presentation:
The classic case involves a healthy, clinically normal young child experiencing intense pain for 10-15 minutes in both legs (knees, thighs, calves, or shins) in the middle of the night 3. The pain is not caused by activity and will not cause a limp 4. In 61% of cases, the pain leads to awakening at night 2.
Critical Diagnostic Uncertainty
There is extremely poor consensus in the medical literature regarding diagnostic criteria for growing pains 1. A 2022 scoping review of 145 studies found that more than 80% made no reference to age of onset, and 93% did not refer to growth 1. This lack of standardization means clinicians should be cautious about relying solely on this diagnosis to direct treatment decisions 1.
When Additional Workup Is Warranted
Red flags requiring further evaluation include 4:
- Atypical history or systemic symptoms
- Physical examination abnormalities (allodynia, focal tenderness, joint swelling, decreased range of motion)
- History of arthritis, trauma, morning stiffness, limping, limitation of activities, or school absence (all significantly more prevalent in other conditions than growing pains) 2
- Unilateral pain
- Pain that causes limping or is related to activity
The ACR guidelines emphasize that in limping children, growing pains should be distinguished from serious pathology through careful history and physical examination 5. The 2025 AASM guideline specifically notes that growing pains, leg cramps, and behavioral issues are mimics of restless leg syndrome in children and require careful clinical differentiation 6.
Important Clinical Relationships
Growing pains may represent an early manifestation or comorbidity with other conditions:
- Migraine: A 2023 prospective study found that 76% of children with growing pains developed migraine over 5 years versus 22% of controls 7
- Restless Leg Syndrome (RLS): Growing pains and RLS share overlapping symptoms, common physiological factors (serotonin dysfunction, iron deficiency, low vitamin D), and familial patterns, suggesting growing pains might be an early form of RLS 8
Management Approach
Treatment consists of symptomatic care 4:
- Massage and over-the-counter analgesics for acute episodes
- Reassurance to children and parents about the benign, self-limited nature
- One small randomized trial showed benefit from leg muscle stretching 9
The condition is self-limiting and does not require imaging or laboratory investigation when the presentation is typical and examination is normal 4, 3.