Growing Pains: When to Be Concerned

Context: The term growing pains describes a common, benign syndrome of recurrent discomfort that occurs in young children. First described in the 1800s, the etiology of this condition remains unclear. The peak incidence does not correspond to a time of rapid growth. Children typically report bilateral pain in the lower extremities that occurs late in the day or at night. Evidence Acquisition: The PubMed database was searched using the keywords growing pains, benign nocturnal limb pains of childhood, recurrent limb pain of childhood, and limb pain in childhood. Articles were also found by reviewing references from the initial PubMed search. Only English-language articles published from 1900 through 2016 were included in the review. Study Design: Clinical review. Level of Evidence: Level 3. Results: When a patient’s history is classic for growing pains and physical examination is normal, laboratory and radiographic evaluation are not needed to make the diagnosis. Findings typical for growing pains include bilateral lower extremity pain usually experienced in the early evening or at night. The pain is not caused by activity and will not cause a limp. Conclusion: Additional workup is warranted for children with an atypical history, systemic symptoms, or for those individuals with physical examination abnormalities such as allodynia, focal tenderness, joint swelling, or decreased joint range of motion. Management of growing pains generally consists of symptomatic care with massage and over-the-counter analgesics, as well as reassurance to children and parents about the benign, self-limited nature of this condition. This review article summarizes data on the epidemiology, etiology, and management of growing pains and provides a framework for distinguishing this entity from other causes of extremity pain.