Growing Pains in Children: Typical Presentation and Management
Growing pains typically present as bilateral lower extremity pain occurring in the late afternoon, evening, or night in otherwise healthy children, particularly around age 3, with normal physical examination findings and complete resolution between episodes.
Clinical Presentation
Typical Features
- Age range: Most common in children 2-12 years old 1, 2
- Pain location: Bilateral lower extremities (knees, thighs, calves, or shins) 1, 3
- Timing: Pain occurs late in the day, evening, or night (often waking the child) 1, 3
- Duration: Episodes typically last 10-15 minutes of intense pain 3
- Pattern: Recurrent episodes with complete resolution between attacks 1
- Physical exam: Normal with no objective findings 1
Key Distinguishing Features
- Pain is not associated with activity and does not cause limping 1
- No morning stiffness or joint swelling 4
- No systemic symptoms (fever, weight loss, malaise) 4
- Child appears completely healthy between episodes 2
Management Approach
Non-Pharmacological Methods
- Massage of the affected areas during pain episodes 1
- Reassurance to both child and parents about the benign, self-limited nature of the condition 1, 3
- Warm compresses may provide comfort 4
Pharmacological Management
- Over-the-counter analgesics as needed during painful episodes 1
Red Flags Requiring Further Evaluation
- Unilateral pain (growing pains are typically bilateral) 4
- Morning pain or stiffness 4
- Joint swelling 4
- Persistent pain that doesn't resolve between episodes 1
- Systemic symptoms (fever, weight loss, malaise) 4
- Abnormal physical examination findings such as:
- Allodynia
- Focal tenderness
- Joint swelling
- Decreased joint range of motion 1
Diagnostic Approach
When presentation is classic for growing pains with normal physical examination, laboratory and radiographic evaluation are not needed 1. The diagnosis is clinical and can be safely established without unnecessary investigations 4.
Prognosis
The prognosis for growing pains is excellent, with the condition being self-limited 2. Parents should be reassured that this is not a serious condition and does not lead to any long-term problems 3.
Common Pitfalls
- Mistaking growing pains for more serious conditions like juvenile arthritis, bone tumors, or infections
- Ordering unnecessary laboratory tests or imaging studies for classic presentations
- Failing to recognize red flags that warrant further investigation
- Not providing adequate reassurance to anxious parents about the benign nature of the condition