Growing pains are described as acute muscular pain in the legs which can cause nocturnal waking. This condition occurs in about 15% of children as early as 1 year old. The child does not limp and symptoms are relieved by massage and simple analgesics.
Typical features:
- Usually non-articular, in 2/3 of children its located in the shin, calves, thighs or popliteal fossa and is almost always bilateral
- Pain usually appears late in the day, and often wakes the child at night
- Duration ranges from minutes to hours, severity can be mild to severe
- By morning the child is almost always pain-free
- Often parents can predict when the child will have pain on days of increased activity
Action: Key assessment points
- Perform the paediatric gait, arms, legs and spine examination (pGALS), check for limp, check joints for restriction/swelling
- Rule out systemic features
- Check skin for a rash, bruising
- Review developmental milestones
- Ensure normal growth (height and weight percentiles)
Action: Referral not indicated
- Typical growing pain presentation with no indications for concern (fits typical features listed above)
- Reassure parent/guardian. Explain the natural benign course of growing pains, reducing parental anxiety. Advice leaflet childhood growing pains
Action: Investigations that may be indicated in Primary Care
- Full blood count
- Acute phase reactants (ESR, CRP)
- Biochemistry (bone biochemistry and vitamin D)
- Thyroid function
- Creatine kinase (CK)
- Growth chart (height and weight)
- XR of legs (hips with frog views)
IMPORTANT NEGATIVES: (normal FBC/ESR, joints normal, no CV features)
Action: Refer to Paediatric Physiotherapy
- There is associated muscle tightness and/or weakness with pain
Action: Refer to Paediatric Orthopaedics
- A limp with positive Pelvic XR findings
- Concern about bony pathology
- Palpable lump in muscle (bakers cyst, semimembranosis bursitis)
Action: Refer to Paediatrician
- Poor appetite and/or weight loss
- Poor growth
- Systemic symptoms
- Pain not relieved by massage or analgesics
- Muscle weakness, extreme fatigue
Action: Refer to Paediatric Rheumatologist
- Joint swelling, pain and morning stiffness indicating inflammatory pathology
- Positive pGALS with restricted joint range of motion
