Etiologies of growing pains

Jun 14 2018

If you are a parent who has been awakened from slumber with a child crying in pain, you can understand my distress at watching my son wake up in pain night after night. My son started having "growing pains" early in toddlerhood-;18 months old was the first episode that I can recall. He would cry, clutching his leg screaming or begging for an icepack. My first thought was that he was experiencing growing pains. But my research as an occupational therapists didn't correlate with how growing pains usually occur. As a mom, I would try to soothe him with my magic kisses. But as an occupational therapist, I tried infant massage and physical agent modalities i.e., heat pack/cold pack. Eventually I'd resort to giving him Tylenol, but his pain has persisted.

My first thought was that he was experiencing growing pains. Growing pains, after all, are the most common cause of musculoskeletal pain in children, with up to 37 percent of children impacted. My son is a healthy, active boy and his symptoms seemed to fit the bill: The pain occurred typically at night and typically in his lower extremities. However, there were some things that just didn't quite match up. Growing pains typically emerge between 3 to 12 years of age and are experienced bilaterally in the lower extremities. For my son, experiencing pain at 18 months old was unusual. Furthermore, his pain came one leg at a time, and sometimes occurred in a wrist or arm.

For peace of mind, we sought advice from our pediatrician, who assured us that my son was experiencing "growing pains." Turns out, "growing pains" are common in children with ligament laxity. We were told to make sure he was well-hydrated and well-rested. Check. Many people think that growing pains occur during "growth spurts," or a period of rapid growth. However, research does not substantiate this notion. Therefore, physicians prefer to refer to this childhood pain experience as "benign nocturnal limb pain of childhood" or "recurrent limb pain of childhood." There are a number of theories out there, but nobody really quite knows for sure why growing pains occur. One thing is for sure: If your child is experiencing pain, your doctor can help determine if the pain is benign or something worth further investigation.

Who

• 2 in 5 children will experience growing pains
• 16 percent of school-age children experience growing pains
• Girls are slightly more affected than boys

When

• Typically occurs in children 3-5 or 8-12
• Pain is experienced at night and is usually gone by morning
• Resolves by teen years

What helps

• Massage
• Heat pads
• Stretching exercises
• Warm bath before bedtime
• Adequate hydration throughout the day
• Use of analgesics like Tylenol or supplementation of vitamin D (consult your physician)

Where

• Usually occurs in both legs
• Front of thighs, calves, shins or back of knees
• Far less frequent; however, some studies have reported pain felt in the upper extremities.

Why

• Anatomic Theory – Musculoskeletal differences, i.e., hypermobility, scoliosis or malalignment in the
• lower extremity, can contribute to altered gait and subsequent pain.
• Bones, muscles, tendons and ligaments all grow, but can grow at a different pace. So if one is
• growing while the other is not, this causes tension and the feeling of pain.
• Family history – Forty-seven percent of childhood growing pains can be linked to family history.
• First-degree history of restless leg syndrome or juvenile idiopathic arthritis and inflammatory bowel
• disease should also be investigated as there may be a genetic significance for autoimmune
• disease.
• Muscular or Skeletal Fatigue Theory, or Overuse Theory – Pain can be caused by overuse in
• children who are active, jumping, running and climbing during the day.
• Psychological Theory – Psychological stress can lead to somatic symptoms.

Researchers continue to investigate the possible etiology of growing pains such as looking at bone density, skeletal vascular perfusion and hypovitaminosis D as contributing factors.

When to seek help

• Complaints of stiffness or pain in the morning
• Pain persists throughout the day
• Pain is relieved by activity but present at rest
• Pain is NOT relieved with massage or analgesics
• Joint swelling, redness, tenderness or warmth
• Limps or favors one leg
• Muscle weakness
• Fatigue
• Decreased activity; pain interferes with normal level of activity
• Fever
• Rash or other skin changes
• Poor appetite and/or weight loss
• Poor growth
• Decreased range of motion; or child is guarding or self-limiting movement at a joint
• Pain is associated with trauma or injury
• Swelling after injury that doesn't resolve in 24 hours, or worsens even after icing
• Dark urine
• Palpable and persistent lump in muscle

Please, always consult your pediatrician if you have any questions or concerns. Sometimes rheumatic or musculoskeletal disease can be the source of a child's pain and be mistakenly treated as growing pains. My son didn't quite fit the profile for "When to Seek Help," but he didn't quite fit the profile for growing pains, either. So, when in doubt, it doesn't hurt to make a phone call to your pediatrician. It's worth the peace of mind.