"Growing pains": a clinical study of non-arthritic limb pains in children.

There is no doubt that children suffer from limb pains more than adults. Since the most obvious difference between the child and the adult is the process of growth, it is hardly surprising that these pains have been dubbed 'growing pains'. An immediate objection is that the pains occur most commonly when growth is far from rapid: the years from 8 to 12, when the pains are most common, form, in fact, one of the 'filling-out' intervals between two of the three periods of rapid general and skeletal growth in childhood. A further criticism is that the commoner sites of pain do not correspond to the sites of maximal growth. Moreover, it appears improbable that pains as intermittent as those described could be related to a process as gradual as that of growth. The idea of any causal relationship between growth and limb pains has, however, never been clearly abandoned, even though many attempts in this direction have been made from time to time. Fifty years ago childhood limb pains were considered to be a manifestation of the 'rheumatic process , and many otherwise healthy children suffered enforced confinement to bed because of the chance association of limb pains with an innocent cardiac murmur. In the period between the two world wars the pendulum swung the other way; an association between rheumatic carditis and growing pains was discounted, despite some suggested evidence to the contrary (Wilson and Kopel, 1926; Seham and Hilbert, 1933). This reaction, beneficial though it was, possibly accounts for the continued lack of recorded observations of children with limb pains. A few studies have been made from the clinical aspect but have contributed little to our knowledge of the underlying processes. On the basis of haemoglobin, leucocyte, and sedimentation rate estimations and measurements of anti-streptococcal agglutinins (Seham and Hilbert), it has been postulated that the pains were due to an infective process, but this interpretation rests on evidence which does not appear to be statistically sound. A newer conception, though one not widely accepted, is that these pains are psychologically determined, possibly as a ' dramatization of persecutions" (Winnicott, 1939), and similar but so-called rheumatic pains in adults have been attributed to psychological causes (Flind and Barber, 1945: Hench, 1948). Sheldon (1946) suggested that growing pains fell into two groups associated respectively with fatigue or with damp weather; this suggestion possesses the merit of attacking the prevalent conception that growing pains represent a single clinical entity. The primary purpose of the work embodied in this paper was to obtain, by clinical enquiry and examination, basic data on limb pains in a school population. The data obtained were compared with those of a control group of children free from pains. The questions to which an answer was sought were. (1) Are persistent non-arthritic limb pains of childhood all of one type and aetiology ? (2) What are the clinical associations of the separate types ?