Typical Presentation of Growing Pains in Children
Growing pains typically present as bilateral lower extremity pain occurring in the early evening or at night in otherwise healthy children between 3-12 years of age, with normal physical examination findings and complete resolution between episodes. 1
Clinical Characteristics
Age and Demographics
- Most commonly affects children between 3-12 years of age
- Peak prevalence of 10-20% in the pediatric population 2
- Despite the name, growing pains do not actually correspond to periods of rapid growth 1
Pain Pattern
- Location: Bilateral pain in lower extremities, typically affecting knees, thighs, calves, or shins 3
- Timing: Pain occurs late in the day or at night, often waking the child from sleep
- Duration: Episodes typically last 10-15 minutes but can persist longer 3
- Intensity: Can be quite severe during episodes
- Periodicity: Recurrent episodes with pain-free intervals between attacks
Key Diagnostic Features
- Pain is bilateral (not unilateral)
- Pain does not persist into the morning
- No limping or activity limitation during the day
- Normal physical examination between episodes
- Child appears completely healthy otherwise
Differentiating Features
What Growing Pains Are NOT:
- Not associated with joint swelling, redness, or warmth
- Not associated with fever or systemic symptoms
- Not caused by activity and will not cause a limp 1
- Not associated with focal tenderness, allodynia, or decreased joint range of motion
- Not persistent throughout the day
- Not unilateral or asymmetric
Red Flags Requiring Further Evaluation
- Unilateral pain
- Pain that persists into the morning
- Associated limping
- Joint swelling or restricted movement
- Systemic symptoms (fever, weight loss, fatigue)
- Focal tenderness on examination
- Pain that interferes with normal activities
Management
- Reassurance to parents about the benign, self-limited nature of the condition 1
- Simple analgesic measures during episodes:
- Massage of the affected areas
- Over-the-counter analgesics (acetaminophen or ibuprofen)
- Local heat application
- Gentle stretching
Common Pitfalls
- Misdiagnosing more serious conditions as growing pains
- Ordering unnecessary laboratory or imaging studies for classic presentations
- Failing to recognize red flags that warrant further investigation
- Dismissing persistent or atypical pain as "just growing pains"
When a child presents with the classic history of bilateral lower extremity pain occurring at night with normal physical examination, the diagnosis of growing pains can be made confidently without additional testing 1. However, any atypical features should prompt consideration of other diagnoses including juvenile idiopathic arthritis, rheumatic fever, bone tumors, or other musculoskeletal conditions 4.