Growing pains in children Yosef Uziel 1 and Philip

We review the clinical manifestations of "growing pains", the most common form of episodic childhood musculoskeletal pain. Physicians should be careful to adhere to clear clinical criteria as described in this review before diagnosing a child with growing pain. We expand on current theories on possible causes of growing pains and describe the management of these pains and the generally good outcome in nearly all children. Background A 6 year-old boy is awakened at 02:00 AM, screaming of painful legs. His parents appreciate severe pain, but do not see anything wrong with his legs. They rub his legs and give him acetaminophen and he returns to sleep with pain resolution within 30 minutes. In the morning he is running about as if nothing occurred at night. The following week he has a similar episode. This causes significant anxiety in the family, and they immediately visit the primary physician. The family worries. What does he have? Is this a serious disease? A tumor? What should the family physician do? In this paper we will review the clinical presentation of this very common pain syndrome, try to understand current knowledge on the pathogenesis and natural course, what the family physician should do, especially in alleviating the family's anxiety. Extremity pain is a common presenting complaint of visits to pediatricians [1-13]. The most common cause of childhood musculoskeletal pain is termed "growing pains" (GP) that exemplifies a type of non-inflammatory pain syndrome. These pains are much more common than all other inflammatory rheumatic diseases. The prevalence of GP ranges from 3–37% of children. Oster found that as many as 15% of school-age children have occasional limb pain [6], and recently Evans and Scutter in a very large community study in Australia reported a prevalence of 37% in children aged 4–6 years [7]. GP mainly affects children between the ages of 3–12 years. GP has typical clinical characteristics; it is usually nonarticular, in 2/3 of children is located in the shins, calves, thighs or popliteal fossa and is almost always bilateral. The pain usually appears late in the day or is nocturnal, often awaking the child. The duration ranges from minutes to hours. The intensity can be mild or very severe. By morning the child is almost always pain free. There are no objective signs of inflammation on physical examination. GP is episodic, with pain-free intervals from days to months. In severe cases the pain can occur daily. In our series of 44 children with GP, 43% had frequency of at least once a week [14]. Often parents can predict when the Published: 19 April 2007 Pediatric Rheumatology 2007, 5:5 doi:10.1186/1546-0096-5-5 Received: 3 January 2007 Accepted: 19 April 2007 This article is available from: http://www.ped-rheum.com/content/5/1/5 © 2007 Uziel and Hashkes; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.