Growing Pains in Children

What growing pains feel like

Children describe a deep ache, cramping or throbbing in the legs. It is typically:

• in both legs, though it may be worse in one on a given night
• in the muscles of the front of the thighs, the calves or behind the knees, not the joints
• in the late afternoon, evening or night, sometimes waking the child
• relieved by rubbing, cuddling and warmth (a child with an infection or fracture usually does not want the leg touched)
• gone by morning, with normal running and play the next day
• more likely after a day of lots of running, jumping or sport

Episodes last from minutes to a couple of hours and come and go over months or years, often with pain-free weeks in between. Some children also have headaches or belly aches with a similar recurring pattern.

What causes growing pains

The cause is unknown. Bones grow slowly and steadily, and growth spurts do not match the timing of the pains, so the name is misleading. Theories include:

• Muscle fatigue from an active day
• A lower pain threshold in some children, who are also more prone to headaches and tummy aches
• Joint hypermobility (very flexible joints) and flat feet, which increase strain on muscles
• Low vitamin D, linked to growing pains in some studies, though not proven as a cause. See vitamin D deficiency.
• Family history: growing pains often run in families
• A possible overlap with restless legs syndrome in some children

Growing pains vs something more serious

Conditions doctors consider

• Juvenile arthritis: joint swelling and stiffness that is worst in the morning, with a limp.
• Osgood-Schlatter disease: pain and a bump below the kneecap in active preteens and teens, worse with activity.
• Sever's disease: heel pain in active children aged 8 to 14.
• Hip problems: Perthes disease (ages 4 to 10) and a slipped upper femoral epiphysis (ages 10 to 15) often cause knee pain and a limp.
• Bone or joint infection (osteomyelitis or septic arthritis): fever, a very tender spot and refusal to walk.
• Leukemia: rarely, bone pain is an early sign, usually with pallor, bruising, fever or tiredness.
• Bone tumors: persistent, worsening pain in one spot, often waking the child.
• Hypermobility: aches after activity with very flexible joints.
• Restless legs syndrome: an urge to move the legs with uncomfortable sensations, relieved by moving rather than rubbing.

How growing pains are diagnosed

Growing pains are a diagnosis of exclusion: the doctor makes it when the story fits and the examination is completely normal. Your pediatrician will ask about the timing, location and sides of the pain, how your child is the next day, and any fever, weight loss or limp. They will examine the joints, spine and hips, watch your child walk and run, and check for flexible joints and flat feet.

Blood tests and X-rays are only needed if there are red flags, such as pain in one leg, a limp, swelling, fever or abnormal blood count signs. Keeping a short diary of when pains happen can help.

How to ease growing pains

• Massage the sore muscles gently.
• Warmth: a warm bath before bed, or a warm (not hot) heating pad or wheat bag.
• Stretching: gentle calf, hamstring and quadriceps stretches in the evening may reduce how often pains occur.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the dose on the label for your child's age and weight, on nights when the pain is bad. Never give aspirin to children.
• Supportive shoes or arch supports if your child has flat feet or hypermobility.
• Reassurance: explaining that the pains are harmless and will go away helps children and parents sleep.

Activity does not need to be restricted. If pains always follow very busy days, a little more rest and stretching after sport may help.

Outlook

Growing pains are harmless and do not affect growth or development. Most children stop having them by adolescence, often within one or two years of starting.

Frequently asked questions

At what age do growing pains start?

Growing pains usually start between ages 3 and 5, or between 8 and 12. They are uncommon before age 2 and usually stop by the teenage years. Pains that begin in a teenager are less likely to be growing pains and are worth getting checked.

Why do growing pains happen at night?

The reason is not known. Pain may become more noticeable when a child is resting and no longer distracted by play, and muscles may ache after a busy day. Pain that appears only at night and is gone by morning is one of the most typical features of growing pains.

When should I worry about growing pains?

See a doctor if the pain is in only one leg, is in a joint, continues during the day, causes a limp, or comes with swelling, redness, fever, weight loss, unusual bruising or tiredness. These are not features of growing pains and need assessment.

Are growing pains caused by growing?

Probably not. Children grow slowly and steadily, and the pains do not line up with growth spurts. Muscle fatigue after activity, flexible joints, a lower pain threshold and family tendency are more likely contributors.

Does vitamin D help growing pains?

Some studies found low vitamin D levels in children with growing pains and fewer pains after supplements, but the evidence is limited. If your child has risk factors for low vitamin D, such as little sun exposure, ask your pediatrician whether a test or supplement is appropriate.