Growing pains in children

Growing Pains: Symptoms

When children complain of acute pain in their legs in the evening or at night, which usually disappears during the day, it is usually growing pains. Even small children can be affected.

The pain is felt alternately in both legs – sometimes one leg hurts, the next time the other, sometimes both hurt at the same time.

Thighs, shins and/or calves are often affected. Growing pains often occur in the knee or foot area. Typically, they cannot be clearly assigned to a specific structure (e.g., a joint or muscle).

Only rarely do adolescents report growing pains in their arms – and if they do, then these occur alongside pain in their legs. Other body regions such as the breastbone, chest or skull are not typical “places” for growing pains.

When boys report testicle pain, some parents think growing pains. Acute pain in the area of ​​the testicles is often caused by injuries (e.g., during sports) or illnesses, such as a torsion of the testicles or an inflammation of the testicles. Be sure to have testicle pain checked out by a doctor!

What do growing pains feel like?

Growing pains express themselves in different ways, for example as dull, cramping or pulling pains. They are felt deep in the tissue. Some children also report noticeable restlessness in their legs.

The severity of growing pains varies. Sometimes they are only noticeable as a slight tugging, then again intense, cramping pains tear children from their sleep.

The duration and frequency of attacks vary

The pain attacks vary in length. Sometimes the symptoms only last a few minutes, then again up to an hour or even several hours.

The pain attacks also vary in their frequency. They can also occur once or twice a week or much less frequently, for example once a month.

Basically, the growing pains are completely gone the next morning.

Checklist – growing pains

The following list highlights important characteristics that are typically observed in growing pains:

• The legs are affected by the pain.
• The pain appears alternately in both legs.
• They do not occur directly in a joint.
• They appear in the evening or at night, but not during the day.
• The painful areas show no redness or swelling.
• Growing pains are not accompanied by a fever.
• The gait pattern is unremarkable, so the child does not limp, for example.
• Children between the ages of three and 12 are usually affected.

Growing Pains: Until What Age?

Growing pains are the most common cause of musculoskeletal pain in early childhood. The specialist literature gives slightly different information about the age group in which they usually occur.

The start of the growing pains is usually set in children at the age of three, sometimes at two or four years of age. Growing pains are not typical for babies.

Specialist sources often give an age of around 12 years as the upper limit – the growing pains disappear by adolescence (puberty). After that, around the age of 14 or 18, pain in the evening or at night typically has other reasons.

What to do about growing pains?

For acute growing pains, doctors recommend rubbing or massaging the affected area. The pain often subsides quickly as a result.

You can also use preparations made from medicinal plants for the gentle massage, for example an arnica preparation (e.g., ointment). The medicinal plant has a pain-relieving effect. But only use arnica preparations that are suitable for children. The pharmacy can advise you on this.

Rubs with St. John’s wort oil can also be beneficial for growing pains. The medicinal plant is said to have a warming, relaxing and pain-relieving effect.

Heat applications can also relieve growing pains in children. The hot-water bottle is a common household remedy. If your child’s feet hurt, they might also like a warm foot bath. The heat can relieve the symptoms for a short time.

In some cases, light exercise drives away the growing pains. For example, the child can ride a bicycle in the air lying on his back. However, if the child does not want to move because of the pain, you should not force them to do so!

Painkillers also counteract the pain. Ibuprofen and paracetamol are suitable for children. The dosage depends on the weight of the child. Ask your doctor or pharmacist about this and the duration of use.

If a child is suffering from chronic ailments, stretching exercises for the muscles are advisable. For example, the child can preventively “stretch” the calf muscles and thigh extensors and flexors before going to bed – after all, the legs are most often affected by growing pains. If necessary, have a doctor or physiotherapist show you suitable stretching exercises.

Under certain circumstances, if the growing pains persist, you can try additional osteopathic treatment. This manual therapy method is often used for back pain. You can find out more about the concept of osteopathy in the article back pain – osteopathy .

The parents of some children rely on alternative healing methods such as homeopathy for growing pains. For example, globules such as Calcium phosphoricum D12 and Rhus toxicodendron D12 should help against the symptoms.

The concept of homeopathy and its specific effectiveness are controversial in science and not clearly proven by studies.

Why do growing pains arise?

No one knows what causes the growing pains. Since adolescents are affected, the suspicion arises that growth processes in the body trigger the symptoms – hence the name “growing pains”.

So far, however, research has not been able to identify a clear mechanism that is primarily responsible for the development of the pain.

In addition, growing pains do not tend to occur in phases in which a child is growing particularly quickly. Conversely, they are also noticeable in offspring whose growth is disturbed or delayed.

Various hypotheses

The causes of growing pains are therefore in the dark. However, there are some hypotheses about this. Here are some examples:

Decreased Pain Threshold: Some researchers suspect growing pains to be a generalized non-inflammatory pain syndrome of early childhood associated with a low pain threshold.

Studies have shown that children with growing pains have a persistently lower pain threshold than children of the same age and gender without these symptoms.

Local overload: According to another hypothesis, growing pains may be the result of local overload of the skeletal system. In affected children, researchers have shown that the bone strength is lower than in healthy ones.

This hypothesis would explain why growing pains in the legs tend to occur late in the day—and often on days when children are physically active.

However, two observations speak against this hypothesis: On the one hand, growing pains also appear on days that were not physically strenuous. On the other hand, the pain can also occur in the arms, and these are generally less stressed than the legs during physical activity.

Genetic tendency: Growing pains run more frequently in some families. This speaks for genetic factors that favour the occurrence of such pain.

Possible risk factors

Greek scientists have discovered a possible connection between growing pains and certain parameters surrounding the birth of affected children. The following factors, among others, appear to be associated with an increased risk of growing pains:

• a low birth weight (< 3000 g)
• a short body length at birth (< 50 cm)
• a small head circumference at birth (< 33 cm)

How common are growing pains?

Growing pains are slightly less common in boys than girls. Its overall frequency is difficult to state – partly because there are no uniform diagnostic criteria and different age groups were often examined in this regard.

Depending on the study, it is assumed that up to 37 percent of children are affected, and in some studies an even higher proportion. Looking only at school-age children, between 10 and 20 percent are said to suffer from growing pains at some point.

How are growing pains diagnosed?

Growing pains are an elusive phenomenon. There is not only a lack of reliable knowledge about their origin – so far there are also no uniform, generally accepted diagnostic criteria. Growing pains are therefore generally a diagnosis of exclusion:

If children of the typical age suffer from the typical pain and no other cause can be found – for example on the basis of imaging methods or laboratory tests – doctors usually make the diagnosis “growing pains”.

The time factor is often taken into account here: the pain attacks must have existed for at least three months.

History and physical examination

To clarify the pain, doctors first collect the medical history of their young patients (anamnesis):

You can have the parents and the affected children (depending on their age) describe the symptoms in more detail. It is important, for example, how these are expressed, how long they have existed and how often they occur.

Other possible questions are, for example, whether the pain in the evening or at night occurs particularly after days of physical activity and whether there are any known underlying diseases in the child.

After the anamnesis interview, a physical examination follows. Doctors examine, among other things, the musculoskeletal system – the whole thing, not just those areas that often hurt. For example, they test the mobility of joints and check the child’s gait for abnormalities.

In the body regions that are usually painful, doctors also look for abnormalities, such as whether the areas are tender or swollen.

Laboratory tests and imaging

Blood tests are also routine. For example, doctors have the inflammatory parameters in the children’s blood measured, such as the blood sedimentation rate and the C-reactive protein. Growing pains are non-inflammatory, which is why the inflammatory values ​​here are unremarkable.

Imaging procedures may also be used, especially X-ray examinations. Here, too, the finding is unremarkable in the case of growing pains.

In individual cases, further examinations may be necessary to rule out other causes of the pain (differential diagnoses) – or to prove them. These can be, for example, more extensive blood tests or magnetic resonance imaging (magnetic resonance imaging, MRI).

Differential diagnoses

When it comes to growing pains, there is a whole range of differential diagnoses – i.e., other possible causes of the pain.

For example, it is important to clarify whether it is actually growing pains or rheumatism. In children, juvenile idiopathic arthritis is the most common. This is the most common rheumatic disease in childhood.

Trauma (such as stress fractures), inflammation (e.g., of the skeletal muscles) and metabolic diseases (such as rickets) are also possible differential diagnoses.

Doctors also have to investigate whether growing pains or tumour diseases such as leukemia are the cause of the symptoms.

Here is a summary of a selection of possible differential diagnoses for growing pains:

• Trauma (e.g. stress fractures, overuse reactions)
• Rheumatic diseases: e.g., juvenile idiopathic arthritis, collagenases (connective tissue diseases), fibromyalgia
• Myositis (inflammation of the skeletal muscles)
• Osteomyelitis (bone marrow inflammation)
• Septic arthritis (bacterial joint inflammation)
• rickets
• Vitamin C deficiency
• Vitamin A excess
• Fabry disease (an inherited metabolic disorder)
• Perthes disease (rare circulatory disorder of the femoral head)
• leukaemia
• lymphomas
• Secondary tumours of cancer tumours (metastases)
• Bone or spinal cord tumours
• Restless Legs Syndrome

Growing pains: course and prognosis

As uncomfortable as growing pains can be, they are benign and nothing to worry about. Parents do not have to fear any consequential damage either.

In addition, the symptoms subside on their own or even disappear spontaneously: Most children get rid of the growing pains after about one to two years.

Growing pains among the children living in the United Arab Emirates (UAE) are a significant concern in the context of rapid development and societal changes. As the country experiences exponential growth, children may face challenges related to adapting to new environments, cultural shifts, and increased academic expectations. Furthermore, the pressure to succeed in a highly competitive society can impact their overall well-being. It is crucial for parents, educators, and policymakers to address these growing pains by prioritizing the emotional and psychological development of children. By fostering supportive and nurturing environments, providing adequate mental health support, and promoting a balanced approach to education, the UAE can ensure that its young generation thrives amidst the opportunities and demands of a rapidly evolving society.