What is the best management for a patient diagnosed with growing pain presenting with bilateral leg pain at night?

Management of Growing Pains in Children

The best management for a patient diagnosed with growing pains is to reassure the mother and patient (Option D), as growing pains are a benign, self-limited condition that requires no imaging, specialist referral, or aspirin therapy. 1, 2, 3

Understanding Growing Pains

Growing pains represent a common, benign syndrome affecting up to one-third of children during early childhood, typically between ages 2-12 years. 1, 3 The condition is characterized by:

• Bilateral lower extremity pain occurring in the late afternoon, evening, or at night 1, 3
• No association with physical activity and no resulting limp 3
• Self-resolving nature with excellent prognosis 4
• Normal physical examination findings 3

Why Each Option is Appropriate or Not

Option A: Orthopedic Referral - NOT INDICATED

• Specialist referral is unnecessary when the diagnosis of growing pains is established through typical history and normal physical examination 1, 3
• Referral should only be considered if red flags are present (see below) 1

Option B: Aspirin - NOT RECOMMENDED

• Aspirin is not the appropriate analgesic for children due to Reye's syndrome risk 1
• When pain relief is needed, over-the-counter analgesics (acetaminophen or ibuprofen) may be used, but the primary management remains reassurance 3
• Most children respond well to massage and stretching of leg muscles without medication 2

Option C: X-rays - NOT NECESSARY

• Laboratory investigations and imaging are not required when the clinical presentation is classic for growing pains and physical examination is normal 1, 3
• Unnecessary testing should be avoided as it may increase parental anxiety about a benign condition 1

Option D: Reassurance - CORRECT APPROACH

• Reassuring the family about the benign, self-limited nature of the condition is the cornerstone of management 1, 2, 3
• This approach addresses parental concerns while avoiding unnecessary interventions 2

Appropriate Management Strategy

The recommended management includes:

1. Parental education and reassurance about the benign nature and self-resolving course 1, 2, 3
2. Symptomatic measures when needed:
   • Massage of the affected limbs 1, 2, 3
   • Stretching exercises for leg muscles 2, 5
   • Over-the-counter analgesics (NOT aspirin) for more severe episodes 1, 3
3. Physical relaxation techniques 2

Critical Red Flags Requiring Extended Evaluation

Additional workup IS warranted if any of the following are present:

• Unilateral pain (growing pains are always bilateral) 1, 3
• Morning stiffness 1
• Joint swelling or decreased range of motion 1, 3
• Systemic symptoms such as fever, weight loss, or malaise 1
• Focal tenderness or allodynia on examination 3
• Limp or activity-related pain 3
• Abnormal physical examination findings 3

These red flags suggest alternative diagnoses such as rheumatic diseases, malignancy, or other serious conditions requiring imaging and laboratory evaluation. 1, 4