health
H
ayley, an eight year old girl,
complained of pain under
her knee joints nearly every
night before bed for two
months. Each evening, her mother had
to massage her legs and apply warm
compresses to relieve the discomfort
so she could go to sleep. During the
day, it didn’t seem to affect her activity,
so Hayley’s mother thought nothing of it
until she brought her to see the doctor
one day and mentioned it in passing.
After an assessment by the doctor,
she was told that Hayley suffered from
growing pains.
If this story sounds familiar to
you, you are not alone. “Growing
pains”, otherwise known as idiopathic
nocturnal pains of childhood, are
some of the most commonly reported
limb pains that can occur in up to one
third of children. 1-3 Their onset can be
from as young as three years and are
slightly more common in girls than
boys. Often, we don’t know why they
occur and a diagnosis needs to be
made after excluding other causes like
trauma, infection, fractures, tumors
or even school phobia. Many have
attributed growing pains to emotional
and psychogenic illness but this is not
well studied.
Growing pains seem to affect children
with higher activity levels, with one study
showing evidence of local overuse as a
contributing factor. They usually affect
the legs but can sometimes affect the
arms as well. There are a number of
growing pain indicators, which include
the following: 2, 5
• Pain occurs later in the day or
awakens the child
•
Pain is not specifically limited to
the joints
• Pain occurs monthly for at least
three months
• Pain is intermittent, with symptom-
free periods of days
• Pain is accentuated by increased
activity on the day
• Normal physical examination and/
or investigations
During an assessment, the
paediatrician will consider the nature
and timing of the pain, its location,
associated activities that trigger it and
any associated symptoms (eg. Fever,
swelling, weight loss or weakness,
headaches or stomach aches). Any
family history of joint or rheumatological
problems and also whether the child
has an adequate intake of calcium and
vitamin D may also be relevant. How
the pain affects a child’s function in life
and in sports is important to gauge.
The paediatrician will examine the
child’s gait and joints as well as muscle
strength and range of movement for
each joint. If anything is abnormal, an X
ray or blood tests may be necessary to
further exclude other factors or make
a diagnosis, though these tests are
expected to be normal in children with
growth pains.
To relieve the pain, here are a
number of things you can do:
• Analgesics like paracetamol or
ibuprofen may be effective.
• Massaging with menthol creams
like Deep Heat rub may also be
useful, but do take care as some
are not licensed for use on children
under 12 years of age.
• Heat packs or hot water bottles
can be applied to the painful areas
for 15-20 minutes at a time which
may help to soothe the discomfort.
• If the pain occurs during sports,
the child should stop the activity
and rest until he or she recovers
from it, but activity can be resumed
after the pain goes away.
• Muscle stretching exercises can
sometimes help with these pains 6 .
• Braces may help to improve
posture and abnormal stresses to
the joint, which possibly will reduce
the pain occurrence, though
should be applied with the advice
of a doctor.
• If a child is found to have low
vitamin D levels, vitamin D and
calcium supplements may help in
the long term.
• If the pain recurs often, it would
be prudent to have it checked by
your doctor.
Parents should be mindful that growth
pains are genuinely painful to the child
and try their utmost to understand and
manage the pain together with the
child, without criticizing or scolding
them for it. Care should be taken not to
let it affect their life or limit their options
for activities and sports. With time, all
children will grow out of it. Your care,
love and sympathy goes a long way in
helping them to cope and manage it.
Dr Euan Soo is a Hong Kong trained
specialist in paediatrics. He has
experience working with neonates,
general paediatrics, infectious
disease and nephrology. He is at both
Central Health and Southside Family
Health Centre.
References
1.
2.
3.
4.
5.
6.
Hawksley JC. Race, Rheumatism and Growing Pains. Arch Dis Child. 1931; 6(35):303
Naish JM, Apley J. “Growing pains”: a clinical study of non-arthritic limb pains in children.
Evans AM, Scutter SD. Prevalence of “growing pains” in young children. J Pediatr. 2004;145(2):255
Friedland O et al. Decreased bone speed of sound in children with growing pains measured by quantitative ultrasound. J Rheumatol. 2005;32(7):1354
Frazer CH, Rappaport LA. Recurrent Pains. In: Developmental behavioral pediatrics, 3rd ed, Levine MD, Carey WB, Crocker AC (Eds), WB Saunders,
Philadelphia 1999. p. 357.
Baxter MP, Dulberg C. “Growing pains” in childhood – a proposal for treatment. J Pediatr Orthop. 1988;8(4):402
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