Growing Pain - Causes, Symptoms, Diagnosis, and Management

What Is Growing Pain?

Growing pain is a harmless aching pain in the children's legs. It can occur in different leg regions, including thighs, calves, shins, and behind the knee. It is usually seen between the ages of three and 12. Both boys and girls can suffer growing pains. Children usually experience this pain in the late afternoon, evening, and night. Growing pain has no relationship with milestones of growth and growth spurts. This condition can affect both legs during the night and may disturb sleep. Generally, the pattern of pain alternates between either side of the body. Around 50 percent of children may suffer this pain once during their lifetime. Pain can occur daily, and in some cases, it may be occasional. French physician Marcel Duchamp first reported growing pain in 1823. The other names for growing pain are:

• Benign nocturnal limb pain of childhood.

• Recurrent limb pain of childhood.

• Limb pain of childhood.

What Causes and Risk Factors Growing Pain?

The exact reason for growing pain is not known. There is no evidence that growth has effects on growing pain. Since the growth rate of bone is slow, even during growth spurts, it does not create any pain. Several theories explain the cause of growing pain, which include:

• Overusing a child's muscles during increased physical activity may cause growing pain.

• Research studies show that children with low pain threshold levels may suffer from growing pain. Headache and stomach pain are also present in such cases.

• Joint hypermobility syndrome is a genetic condition that occurs due to increased flexibility of joints. Pain and tightness of muscles and joints may occur in this syndrome.

• A flat foot is a condition due to an underdeveloped foot arch. Flat feet are common in babies. Foot arch usually develops at the age of six years.

• Decreased vitamin D levels in the body may affect bone strength.

• Poor body posture creates excess strain on the supporting muscles.

• Emotional stress may also contribute to growing pain.

• The pain mainly occurs due to jumping, running, or climbing in the daytime, which causes pain in the night.

What Are the Signs and Symptoms of Growing Pain?

The symptoms of growing pain may vary in different children. Pain may come and go for weeks or months; sometimes, it may last for years. A throbbing or aching pain can occur in both legs over the muscles. Joints are usually not involved. Children with growing pain usually experience it in the late afternoon, evening, or night, and it goes away by morning. Rarely do children experience pain over the arm along with leg pain. This pain may be accompanied by headache and stomach pain in some cases. This pain can cause difficulty in sleeping during the night.

How Can Growing Pain Be Diagnosed?

Growing pain can be generally diagnosed by taking a history and undergoing a physical examination. The other medical tests are usually not required. The healthcare professional will mostly diagnose this condition by inquiring about medical history and characteristic symptoms. In physical examination, healthcare professionals will look for pain location, duration, and when the pain occurs and also enquire about pain episodes and patterns. Increased physical activity like exercising, jumping, running, and sports during the daytime may lead to growing pain at night. All these factors are important to distinguish growing pain from other medical conditions. If the children are healthy and active and do not have any pain during the daytime, no other tests are advised. There are no specific blood tests or imaging tests for this condition. However, if the child is having continuous pain at the same location, increasing throughout the day, along with swelling, redness, and joint stiffness, the doctor will suggest imaging tests or blood tests that identify the exact cause of the pain.

How Is Growing Pain Treated?

The treatment of growing pain may differ based on the severity. The healthcare professional may suggest methods to relieve pain. The methods of pain management include:

• Reassuring the patient that the pain will subside and their legs will feel comfortable by morning.

• Gently massage the affected leg using massage oils.

• Stretching the muscles of the affected leg.

• Heat application over the affected area using a heating pad or warm cloth.

• Medications to relieve pain include NSAIDs (non-steroidal anti-inflammatory drugs) like Paracetamol or Ibuprofen.

• If the patient's feet trip a lot, seek the advice of a podiatrist to check posture and their legs.

• Encourage the children to perform various physical activities like playing and running; otherwise, children may become afraid of such activities because of growing pain.

When Should a Person See a Doctor?

The doctor should be contacted in the following cases:

• If pain occurs during the daytime.

• Pain is because of some trauma or injury.

• Pain that does not subside with heat, massage, and painkillers. Pain is persistent.

• Redness, pain, and joint pain.

• Poor appetite, weight loss, and fever occur.

What Are the Other Conditions Having Symptoms Similar to Growing Pain?

1. Restless Leg Syndrome: A disorder affecting the nervous system that causes an uncontrollable urge to move the legs.

2. Osteosarcoma: A bone cancer that affects the bone-forming cells.

3. Juvenile Idiopathic Arthritis: It is a long-lasting condition in children, resulting in swelling, stiffness, and joint pain.

4. Fibromyalgia Syndrome: A chronic medical condition that causes muscle pain, stiffness, and tenderness.

5. Injury: Certain injuries may cause pain similar to growing pain, which includes:

• Sprains: It is a soft tissue injury due to the tearing of the ligament (a band of fibrous tissue connecting two bones' ends).

• Hematoma: It presents as a collection of blood outside the blood vessel.

• Osgood-Schlatter Disease: It is a condition that affects children in growth spurts. It occurs due to inflammation of the tendon situated below the knee. It is a common cause of knee pain in children.

• Due to an insect sting or bite injury.

• Fracture of bone.

6. Infections: Infectious causes include:

• Abscess: It occurs due to abnormal collection of pus or infected fluid anywhere in the body.

• Cellulitis: It is a serious medical condition that affects the deeper layer of the skin and is caused by bacteria.

• Osteomyelitis: It is a serious infection affecting bone caused by fungi or bacteria.

Conclusion:

Growing pain is a mild medical condition usually seen in children. The occurrence of this condition does not have any underlying cause. Even though growing pain is painful, it does not cause any damage to a child’s muscles or bones. Most of the symptoms of growing pain respond well to treatment methods. However, it is important to see a healthcare professional to confirm the diagnosis and ensure the pain is not occurring due to any other medical condition.