How are growing pains in children managed?

Management of Growing Pains in Children

Growing pains in children should be managed primarily with non-pharmacological interventions including massage, heat application, and reassurance, with over-the-counter analgesics like acetaminophen or ibuprofen reserved for more severe episodes.

Clinical Characteristics of Growing Pains

Growing pains typically present with the following features:

• Bilateral lower extremity pain (knees, thighs, calves, or shins)
• Pain occurs in the early evening or at night, often waking the child
• Pain lasts approximately 10-15 minutes, though can be intense
• No pain during the day or with activity
• No associated limp or functional limitation
• Normal physical examination
• Healthy children with no systemic symptoms

Diagnostic Approach

Before diagnosing growing pains, ensure:

• No focal tenderness, joint swelling, or decreased range of motion
• No allodynia or other abnormal physical findings
• No systemic symptoms (fever, weight loss, fatigue)
• No limping or activity limitation
• Pain is bilateral rather than unilateral

When history is classic for growing pains and physical examination is normal, laboratory and radiographic evaluation are not needed 1.

Management Strategy

First-Line Interventions (Non-Pharmacological)

1. Massage therapy: Gentle massage of the affected areas during pain episodes
2. Heat application: Warm compresses or heating pad to painful areas
3. Reassurance: Explain the benign, self-limited nature of the condition to both child and parents 1, 2
4. Distraction techniques: Age-appropriate distraction such as:
   • Reading stories
   • Watching cartoons
   • Listening to music 3

Second-Line Interventions (Pharmacological)

For more severe episodes, over-the-counter analgesics can be used:

• Acetaminophen: Appropriate weight-based dosing
• Ibuprofen: Can be used safely for pain management 4

Parent Education

Parents should be educated on:

• The benign nature of growing pains
• Expected duration (typically self-resolves)
• How to assess pain using age-appropriate pain scales
• When to administer pain medication
• Creating a comfortable environment that minimizes distress 4

Special Considerations

When to Seek Further Evaluation

Refer for additional workup if:

• Pain is unilateral
• Pain persists during daytime or affects activity
• Physical examination reveals abnormalities
• Child develops systemic symptoms
• Pain is associated with limping 1

Pain Assessment Tools

• Wong-Baker FACES scale: Validated for children 3 years and older
• FLACC scale: (Face, Legs, Activity, Cry, Consolability) - validated for children 2 months to 7 years 4
• Numeric scale: For older children (0 = no pain, 10 = worst pain)

Prognosis

Growing pains have an excellent prognosis with nearly all children experiencing complete resolution 5. Parents should be reassured that:

• The condition is not associated with any serious underlying disease
• The pains are not actually related to growth
• No long-term complications are expected

By following this management approach, most children with growing pains can achieve adequate pain relief with minimal intervention while avoiding unnecessary diagnostic testing or more aggressive treatments.