July 13, 2009
By Claire McCarthy, M.D.
Boston Children's Hospital
It's a story I hear frequently from worried parents: Their child has leg pains that come and go. The parent can't see anything wrong, but the pain makes the child miserable. Sometimes it's bad enough to wake the child from sleep.
When I hear this, the diagnosis nearly always ends up being growing pains.
"Growing pains" are very common. They affect up to a third of children. They peak at around age 6. The pains usually occur once or twice a week, but they can happen every day. Between episodes, the child is pain-free. These pains usually:
- Affect both legs but not usually both at once
- Seem to come from the muscles rather than the joints
- Occur in the lower legs
- Come on suddenly, usually in the late afternoon or at night
- Are not associated with redness, swelling or any other physical signs
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Where Do Growing Pains Come From?
We don't know what causes growing pains. One thing that probably doesn't cause them is growing. There's no evidence that growth hurts. But there are theories about what causes them:
- A low pain threshold Some kids may just be more prone to feeling pain than others.
- Overuse Growing pains are more likely to occur after lots of physical activity.
- Problems with blood flow Specialists think blood-flow problems could explain growing pains, but there's no evidence to back this up.
- Psychological factors There is speculation that psychological stress in both the child and the family may make the pains more likely to occur.
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Making the Diagnosis
Growing pains are what we call a "diagnosis of exclusion." This means that we rule out other possible causes of pain before we say a child is suffering from growing pains. These may include injuries, arthritis or even cancer, which is incredibly rare, so don't worry! If your child is complaining of leg pains, make an appointment with your doctor.
Whenever I see a child with leg pains I ask lots and lots of questions. I also do a very careful examination. Sometimes I will order blood tests or do imaging studies like X-rays or a bone scan. I'm much more likely to do this if:
- The pain is becoming more frequent or getting worse
- The pain is in just one leg
- The pain is in a joint
- There was an injury around the time the pain started
- There is swelling, redness or another physical sign
- The child has other signs of illness, such as fever, rash, weight loss or decreased energy
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What Parents Can Do
Once I've made the diagnosis of growing pains, the biggest thing I have to offer families is reassurance that there is nothing serious going on. These pains eventually go away on their own by the time a child becomes a teen. In the meantime, there are some things that parents can do to help:
Try massage Rubbing the affected area can make a difference. Apply heat Buy a heating pad, and have it handy. Give ibuprofen or acetaminophen Check with your doctor for the correct dose. Remember: Never give aspirin to children. Stay calm The pain is real and can be scary for children. It's important to soothe the child. Let them know that you are going to be with them and that the pain is going to go away. Watch for triggers Some parents can predict when the pains are going to come, based on their child's activity or mood. I certainly would never want to limit a child's activity, but a warm bath or some ibuprofen before bedtime may help ward off the pain.
Don't worry if you can't predict when the pain is coming. In fact, don't worry is the most important message of all when it comes to growing pains. They will pass, like the other trials and tribulations of childhood just in time for the trials and tribulations of adolescence. Ah, parenthood!
Claire McCarthy, M.D., is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.