Ask the Lab: Growing Pains vs. Injuries

August 9, 2010 10:05 AM
Growth related pains are different from injuries in children.
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Question: Can you explain what growth related pain is and how this is different to an injury?
Nicole V. Naples, FL
From: Dr. David Westerdahl:
Growing pains are typically self limited extremity pains for which a specific diagnosis cannot be found. Growing pains may affect up to 15% of children. Most children present with pain that occurs late in the day or awakens the child at night. Growing pains may interrupt normal activity including sleep. This pain may occur monthly and last for at least three months. Usually, growing pains are intermittent with symptom free periods.
Growing pains generally begin between 2 and 12 years old. Growing pains may be slightly more common among girls than boys. Growing pains occur predominantly in the lower extremities. The pain is bilateral (both limbs) and located deep in the legs, usually the thigh or calf.
The true cause of growing pains is not known. Usually the physical exam, laboratory data, and radiographs are normal. Growing pains are not necessarily caused by growth and do not coincide with periods of rapid growth. Fortunately, growing pains will not affect the growth of children who experience them.
Clinicians try to restrict the diagnosis of "growing pains" to the description of children with pain awakening them at night who are without other symptoms or signs of musculoskeletal problems. Obviously, this is different from children with joint pains during activity. Muscle and joint pains associated with activity need further investigation. It is important for clinicians and parents not to dismiss as "growing pains" a significant problem that needs treatment.
Additional evaluation usually is warranted in children who have unexplained fevers, weight loss, unilateral (one sided) limb pain, pain during the day, or limping. Some exam findings like decreased range of motion, warmth, tenderness, and swelling should necessitate additional work up. Also, pain in the spine, arms, or groin area needs further evaluation.
Treatment of growing pains usually involves educating the patient and family about the diagnosis. Massage, heat, stretching, and analgesics like acetaminophen or ibuprofen may be useful. Currently, we advise parents not to discontinue normal activities as it won’t prevent growing pains.
Remember, if the child appears ill, complains of pain during the day or with activity, or if the pain worsens or persists, the diagnosis is unlikely growing pains. A thorough evaluation is needed in children who experience these symptoms.
David N. Westerdahl, MD, FAAFP is a Staff physician for the Department of Orthopedics at Cleveland Clinic Florida.  He completed a Primary Care Sports Medicine fellowship in the Department of Orthopedic Surgery at Cleveland Clinic's main campus in Cleveland, Ohio.

With a background in primary care and sports medicine, Dr. Westerdahl manages a wide range of non-operative orthopedic and sports medicine injuries. He serves as the Consulting Physician for The USTA Training Center - Headquarters in Boca Raton, Florida. He is also the Team Physician for the Florida Panthers, and Director for Sports Medicine at Florida Atlantic University. His specialty interests include sports injuries, medical orthopedics, exercise related medical disorders, musculoskeletal ultrasound, nutritional supplements and wilderness medicine.