Management of Growing Pains in Children
The first-line management for children experiencing growing pains should include non-pharmacological approaches such as massage, heat application, and distraction techniques, with acetaminophen or ibuprofen as needed for pain relief. 1
Understanding Growing Pains
- Growing pains are a common, benign syndrome of recurrent discomfort that occurs in young children, typically characterized by bilateral lower extremity pain that occurs late in the day or at night 2
- Despite the name, growing pains are not actually related to periods of rapid growth 2
- The condition is self-limited and has an excellent prognosis 3
Non-Pharmacological Management
Primary Approaches
- Warm compresses or heating pads applied to affected areas help relax muscles and reduce discomfort 1
- Massage of the affected areas during pain episodes provides significant relief 4
- Distraction techniques are highly effective in reducing pain perception and improving patient cooperation 5, 1
- Cognitive behavioral strategies such as guided imagery, breathing exercises, and relaxation techniques are very effective in reducing pain 5
Parent/Caregiver Education
- Provide reassurance to parents and children about the benign, self-limited nature of growing pains 4
- Teach parents to identify signs of pain and implement appropriate pain management techniques 5
- Encourage parents to function as "coaches" for cognitive behavioral strategies, providing encouragement for coping mechanisms 5
Pharmacological Management
First-Line Medications
- Acetaminophen (paracetamol) is recommended as a safe first-line analgesic option 1, 6
- Ibuprofen or other NSAIDs can be used judiciously, recognizing that adverse effects such as gastrointestinal issues are rare in children 1, 6
- Medication should be administered on a regular schedule during pain episodes rather than waiting for pain to become severe 5
Administration Considerations
- For children who refuse oral medication, rectal acetaminophen may be considered 5
- Pain medication should be given on a regular schedule during episodes rather than as-needed 5
- Alternating medications such as ibuprofen and acetaminophen may be recommended for better pain control 5
Pain Assessment
- Always use validated age-appropriate pain scales to assess pain severity 5
- Options include:
When to Consider Additional Evaluation
- Additional workup is warranted for children with:
- Atypical history (unilateral pain, pain that occurs with activity, or causes limping) 2
- Systemic symptoms (fever, weight loss, fatigue) 2
- Physical examination abnormalities (allodynia, focal tenderness, joint swelling, decreased range of motion) 2
- Pain that significantly impacts daily functioning or quality of life 1
Common Pitfalls to Avoid
- Undertreatment of pain in children - pediatric pain is frequently underestimated and inadequately treated 5, 1
- Waiting for pain to become severe before treating - proactive, scheduled administration of analgesics is more effective 7
- Overlooking the importance of non-pharmacological interventions, which should supplement pharmacological treatments 5
- Failing to provide clear instructions to parents regarding pain assessment and management 5
Special Considerations
- Anxiety management is important, as pain episodes can cause anxiety in both children and parents, which may exacerbate symptoms 1
- Parental participation in pain management techniques is essential for effective implementation at home 5
- Maintain normal activities and routines as much as possible to promote functional improvement 8