The mysterious growing pains 

by Marcin Gornsiewicz, M.D.Your 5-year-old child wakes up in the middle of the night screaming from pain, crying, and pointing toward the legs. You look at them but you don’t see anything wrong. You rub them and the child is in deep sleep again within thirty minutes. When your child wakes up in the morning, he/she is absolutely fine, no pain or limping, ready for daily activities like nothing ever happened. The same thing occurs again a week later, this time even more dramatic, disrupting sleep for the whole family. You are now seriously worried and ask yourself questions. Is my child really in pain, or is he/she faking it? Is it serious? Should I call my doctor?If this story sounds familiar, chances are your child is experiencing growing pains.First described in medical literature in 1823 by a French doctor, growing pains affect up to 37% of preschoolers beginning usually in children between 4 and 6 years old. The pain starts late in the day or at night (especially in the first few hours). It is located in the legs in shins, calves, thighs or behind and around the knee and ankle. It affects both legs but not necessarily at the same time. The pain can be mild, but it is sometimes severe, waking the child as if from a bad dream. The child may cry or scream, demanding your full attention. There is nothing that parents can see, no bruising, redness or swelling. It will last 10 to 30 minutes, relieved by massage, heat, and the child will completely fine in the morning without pain or limping, ready for another full day of action.Growing pains are episodic, and they may disappear for weeks or months only to start up again. Some kids may experience them on daily basis. Growing pains will always go away. It is just a matter of time. Usually they disappear completely by age 14. They don’t interfere with proper growth or development, they are not associated with any specific rheumatic condition nor do they increase the chance of any systemic disease.So, what is going on? Where does the pain come from? Well, nobody really knows, but one thing is certain. This is not arthritis, in spite of its name it has nothing to do with growth, and it has nothing to do with Kirk Cameron and the successful TV series Growing Pains from the early 90’s. Parents have observed that growing pains are often worse after an increased level of physical activity,  so perhaps just simple local overuse is a factor. It has been noted that children with hyper-mobility syndrome (double-jointed) and with flat feet are more prone to having growing pains. Some studies show a connection to emotional stress. Finally, there is likely a genetic predisposition, as growing pains tend to run in the family.“Growing pains will always go away. It is just a matter of time. Usually they disappear completely by age 14.”It is important to understand the benign nature of this condition. The pain can be controlled by gentle massage, heating pads, light stretching of the legs, over the counter pain killers and reassurance. Your smile, hug, calm behavior will usually do the trick. There is no need to change your children’s normal daily activities. If they are involved in competitive sports, let them continue. In children waking up with pain several nights in a row, an evening dose of Tylenol or Ibuprofen just before they go to bed may brake the cycle.For children with typical growing pains, there is no need to do any laboratory or imaging tests, and a visit to the doctor is usually not necessary. However, be aware of symptoms that are not seen in growing pains that would require a full medical evaluation. These include:pain during the daypain that is present only in one leg and only in one locationlimping and decreased activityfever and weight losslocal warmth, tenderness or swellingIf you have any doubts about the diagnosis, contact your pediatrician.In conclusion, growing pains are real and sometimes look very dramatic but they are harmless, there is no damage to child’s bones, joints, muscles or growth plates. They will go away like the television show.Dr. Marcin Gornisiewicz graduated with an MD degree from the Medical School of Warsaw in Warsaw, Poland. He completed residency training in internal medicine at Saint Barnabas Medical Center in Livingston, New Jersey. He completed fellowship training in rheumatology at the University of Alabama at Birmingham in Birmingham, Alabama. He joined Rheumatology Consultants, PLLC (rheumatologyconsultants.org) in 2002. He is board certified in Rheumatology.