What Growing Pains Feel Like
Growing pains present as recurrent, bilateral lower extremity pain that occurs in the late afternoon, evening, or at night, typically affecting the knees, thighs, calves, or shins in otherwise healthy children aged 2-12 years. 1, 2
Pain Characteristics
The pain has several distinctive features that help identify this benign condition:
- Timing: Pain occurs predominantly at night or in the early evening, often waking children from sleep 3, 2, 4
- Duration: Episodes are brief, typically lasting 10-15 minutes, though they can persist longer 1
- Intensity: The pain can be intense and severe during episodes, despite the benign nature of the condition 4
- Location: Always bilateral, affecting both legs simultaneously in the knees, thighs, calves, or shins 1, 2, 5
- Quality: The discomfort is described as deep, aching pain in the muscles rather than joints 2, 4
Key Distinguishing Features
Growing pains have specific characteristics that separate them from serious pathology:
- No activity relationship: The pain is not caused by physical activity and does not occur during or immediately after exercise 2
- No limp: Children do not limp or show gait abnormalities, even during painful episodes 2
- Normal examination: Physical examination between episodes is completely normal with no joint swelling, tenderness, or decreased range of motion 2, 4
- Self-resolving: Episodes resolve spontaneously without intervention, and the condition eventually disappears with time 3, 5
Red Flags That Suggest Alternative Diagnosis
Certain features should prompt investigation for other conditions rather than growing pains:
- Unilateral pain: Growing pains are always bilateral; one-sided pain warrants further evaluation 4
- Morning stiffness: Presence of stiffness upon waking suggests inflammatory arthritis rather than growing pains 4
- Persistent daytime symptoms: Pain that interferes with daily activities or causes limping is not consistent with growing pains 2
- Systemic symptoms: Fever, weight loss, malaise, or other constitutional symptoms indicate serious pathology 4
- Joint abnormalities: Swelling, warmth, redness, focal tenderness, or decreased range of motion require extended workup 2, 4
Clinical Context
Despite the name, growing pains are not actually caused by growth, and their peak incidence does not correspond to periods of rapid growth 2. The etiology remains unclear, though mechanical factors (joint hypermobility, flat feet), decreased pain thresholds, and reduced bone strength may contribute 4. This is a diagnosis of exclusion that affects up to one-third of children at some point during early childhood 4.