Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Growing Pains

Basics
Description
  • This poorly understood syndrome is characterized by a long history of lower extremity pains that usually occur at night and worsen after active days.
  • Pain:
    • Resolves completely each time it occurs
    • Occurs predominantly in the lower extremities
    • Occurs in 1 or both legs with random frequency
  • No objective physical findings are seen.
  • Synonyms: Leg aches; Night pains
Epidemiology
Incidence
  • Very common
  • An estimated 15-36% of children complain of these pains at some time.
Prevalence
  • Occurs in children 3-10 years old
  • Slightly more common in girls than in boys
Risk Factors
High activity levels in normal young children
  
Etiology
  • The condition is believed to be secondary to stretch or fatigue of muscle.
  • Support for this theory:
    • The fact that bones grow primarily when they are unloaded
    • The beneficial response that many children have to a stretching program
Diagnosis
Signs and Symptoms
  • Signs:
    • Nonspecific for this condition
    • No localized tenderness
    • No limp
    • Full ROM
  • Symptoms:
    • Pains occur after periods of activity, most often at night.
    • Pains come and go spontaneously.
    • Pains most often are bilateral, vague, and poorly localized.
    • Symptoms are often of long, though intermittent, duration, a feature that helps to rule out more serious causes.
Physical Exam
  • Usually, with a careful history and physical examination, one can rule out more serious causes and define a typical picture.
  • The child should be observed while walking into the office, especially before the child knows that the examiner is watching; there should not be any stiffness or limp.
  • The lower extremities should be palpated systematically for tenderness; growing pains do not manifest tenderness.
  • The ROM of the hips, knees, and ankles should be checked.
    • The hips, in particular, should show no stiffness or guarding on gentle rolling (the roll test).
    • ROM should be full and symmetric.
Tests
Lab
  • If the history is not typical:
    • Complete blood count and ESR may be done.
    • An appropriate workup tailored to the possibilities listed in the differential diagnosis should then be undertaken.
Imaging
  • Bone scans and plain radiographs may help to define the site of pain if the history is not typical.
  • However, these tests are not needed in most cases.
Differential Diagnosis
  • Perthes disease
  • Chronic or subacute osteomyelitis
  • Leukemia
  • Sickle cell anemia
  • Juvenile rheumatoid arthritis
  • Lyme disease
  • OSD (older child)
  • Restless leg syndrome
Treatment
General Measures
  • If the diagnosis of growing pains fits the history, reassuring the parent and child is the 1st step.
  • A program of stretching for the hamstrings, quadriceps, and calf muscles at night before bed has been shown to decrease the number of complaints, perhaps by mechanical means or by virtue of increased parent-child interaction.
  • Activity levels may need to be modified to bring symptoms into a tolerable range.
Special Therapy
Physical Therapy
The stretching program described under General Measure may be guided by parents and does not require a trained therapist.
 
Medication
Analgesics may be used periodically, but not continuously.
 
Follow-up
Prognosis
Spontaneous resolution is the rule as the patient matures.
 
Patient Monitoring
  • Several successive office visits may be needed to show the character of the pain or to determine the direction of the workup.
  • The stretching program is maintained, and the activity level is adjusted as needed.
Miscellaneous
Codes
ICD9-CM
729.5 Growing pains
 
Patient Teaching
  • Describe the nature of the process.
  • Instruct in stretching exercises.
  • Offer to see the patient any time the symptoms change.
FAQ
Q: Is growing pains a real condition?
A: Although the pathogenetic mechanism is lacking, most specialists agree that a constellation of symptoms, with a history of spontaneous resolution, is seen frequently by pediatricians and orthopaedic surgeons everywhere.
 
Q: Is physical therapy necessary?
A: It is better to maximize parent-child interaction by stretching.

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