Can growing pains cause hypercalcemia?

Growing Pains Do Not Cause Hypercalcemia

Growing pains do not cause elevated calcium levels (hypercalcemia) in children. Growing pains are a benign, non-inflammatory pain syndrome of childhood that has no documented association with hypercalcemia in medical literature 1, 2.

Understanding Growing Pains

Growing pains are characterized by:

• Bilateral lower extremity pain, typically in knees, thighs, calves or shins
• Pain occurring primarily at night
• Normal physical examination
• No laboratory abnormalities
• Self-limiting condition

Growing pains affect up to one-third of all children at some point during early childhood 1. While the exact mechanism remains unclear, potential contributing factors include mechanical factors (joint hypermobility, flat feet), decreased pain thresholds, reduced bone strength, and emotional factors 1.

Relationship Between Growing Pains and Calcium

Some studies have investigated vitamin D and calcium supplementation in children with growing pains:

• A 2023 study found that calcium and vitamin D supplementation helped some children with growing pains, but the effect was significantly better when combined with iron supplementation 3.
• A 2011 study found that 94% of children with growing pains had hypovitaminosis D (insufficient or deficient vitamin D levels) 4.

However, these studies do not suggest that growing pains cause hypercalcemia. In fact, they suggest the opposite - that some children with growing pains may have inadequate calcium metabolism.

Causes of Hypercalcemia in Children

Hypercalcemia in children is a distinct clinical entity with specific causes that are unrelated to growing pains. According to pediatric guidelines, hypercalcemia in children can be classified as 5:

1. PTH-dependent causes:

   • Primary hyperparathyroidism
   • Tertiary hyperparathyroidism (associated with chronic renal failure)
   • Familial hypocalciuric hypercalcemia
   • Multiple endocrine neoplasia syndromes

2. PTH-independent causes:

   • Williams syndrome (genetic disorder with idiopathic infantile hypercalcemia) 6
   • Hypervitaminosis D
   • Granulomatous disorders
   • Endocrinopathies
   • Malignancy-associated hypercalcemia

Clinical Presentation of Hypercalcemia

Hypercalcemia in children typically presents with:

• Hypotonia
• Poor feeding
• Vomiting
• Constipation
• Abdominal pain
• Lethargy
• Polyuria
• Dehydration
• Failure to thrive
• Seizures (in severe cases)

These symptoms differ significantly from the typical presentation of growing pains, which are characterized by bilateral leg pain occurring at night in otherwise healthy children 1, 2.

Management of Hypercalcemia

When hypercalcemia is identified in a child, management should focus on:

1. Aggressive IV fluid resuscitation with normal saline as first-line treatment 7
2. Pharmacological interventions based on severity and cause:
   • Bisphosphonates
   • Denosumab (for refractory cases or severe renal impairment)
   • Glucocorticoids (for vitamin D toxicity or granulomatous disorders)
   • Calcitonin (for immediate short-term management of severe cases)
3. Regular monitoring of serum calcium, phosphate, magnesium, and renal function 7
4. Treatment of the underlying cause

Important Considerations

If a child presents with suspected growing pains but has laboratory evidence of hypercalcemia, clinicians should:

1. Rule out other conditions that can cause both limb pain and hypercalcemia
2. Consider Williams syndrome, which can present with hypercalcemia and musculoskeletal symptoms 6
3. Evaluate for other causes of hypercalcemia as outlined above
4. Monitor calcium levels regularly, as hypercalcemia can lead to serious complications including dehydration, hypercalciuria, and nephrocalcinosis 6, 7

Conclusion

Growing pains are a benign condition of childhood that do not cause hypercalcemia. If a child presents with both growing pains and hypercalcemia, these should be considered as separate clinical entities, and the hypercalcemia should be thoroughly investigated to identify its underlying cause.