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, and occasionally both legs hurt at the same time.
The thigh, shin and/or calf are frequently affected. Growing pains also often occur in the knee or foot area. Typically, it cannot be clearly assigned to a specific structure (such as a joint or muscle).
Only rarely do adolescents report growing pains in the arms – and when they do, they accompany pain in the legs. Other areas of the body such as the sternum, ribcage or skull are not typical “locations” for growing pains.
When boys report testicular pain, some parents think of growing pains. However, acute pain in the area of the testicles is often caused by injuries (e.g. during sport) or illnesses, such as a twisted testicle or testicular inflammation. It is essential to have testicular pain checked out by a doctor!
What does growing pains feel like?
The severity of growing pains varies. Sometimes it is only noticeable as a slight pulling sensation, sometimes intense, cramp-like pain wakes children from their sleep.
The duration and frequency of attacks vary
Pain attacks vary in length. Sometimes the pain only lasts a few minutes, then again up to an hour or even several hours.
The frequency of the pain attacks also varies. They can occur once or twice a week as well as much less frequently, for example once a month.
However, growing pains generally disappear completely the next morning.
Checklist – growing pains
The following list shows important characteristics that are typically observed with growing pains:
- The legs are affected by the pain.
- The pain occurs alternately in both legs.
- It does not occur directly in one joint.
- It occurs 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 fever.
- The gait pattern is unremarkable, for example the child does not limp.
- Children between the ages of three and 12 are usually affected.
Growing pains: Up to what age?
For example, growing pains usually start in children at the age of three, sometimes also at the age of two or four. In babies, growing pains are atypical.
Specialist sources often cite an age of around 12 years as the upper limit – growing pains disappear by adolescence (puberty). After that, around the age of 14 or 18, evening or night-time pain typically has other causes.
What to do about growing pains?
For acute growing pains, doctors recommend rubbing or massaging the affected area. This often relieves the pain quickly.
You can also use preparations made from medicinal plants for gentle massaging, for example an arnica preparation (e.g. ointment). The medicinal plant has a pain-relieving effect. However, only use arnica preparations that are suitable for children. Pharmacists can advise you on this.
Rubbing 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 alleviate growing pains in children. A hot water bottle is a common household remedy. If your child’s feet hurt, they may also like a warm foot bath. The heat can relieve the discomfort for a short time.
Painkillers also counteract the pain. Ibuprofen and paracetamol are suitable for children. The dosage depends on the child’s weight. Ask your doctor or pharmacist about this and the duration of use.
If a child is suffering from chronic pain, stretching exercises for the muscles are advisable. For example, the child can “stretch” the calf muscles and thigh extensors and flexors as a preventative measure before going to bed – the legs are most frequently affected by growing pains. If necessary, ask a doctor or physiotherapist to show you suitable stretching exercises.
If growing pains persist, you may also be able to try osteopathic treatment. This manual therapy method is often also 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 are said to help with the symptoms.
The concept of homeopathy and its specific effectiveness are controversial in the scientific community and have not been clearly proven by studies.
Why does growing pains occur?
However, research has not yet been able to identify a clear mechanism that is primarily responsible for the development of the pain.
Furthermore, growing pains do not occur preferentially in phases when a child is growing particularly fast. Conversely, it is also noticeable in children whose growth is disturbed or delayed.
Various hypotheses
The causes of growing pains are therefore a mystery. However, there are several hypotheses. Here are a few examples:
Reduced pain threshold: some researchers suspect that growing pains are a generalized non-inflammatory pain syndrome of early childhood that is related to a low pain threshold.
Studies have shown that children with growing pains have a persistently lower pain threshold than offspring of the same age and sex without these complaints.
Local overloading: According to another hypothesis, growing pains may be the result of local overloading of the skeletal apparatus. Researchers have shown that affected children have less bone strength than healthy children.
This hypothesis would explain why growing pains in the legs usually occur late in the day – and often on days when children were physically active.
Genetic predisposition: Growing pains occur more frequently in some families. This indicates genetic factors that favor the occurrence of such pain.
Possible risk factors
Greek scientists have discovered a possible link between growing pains and certain parameters surrounding the birth of affected children. According to this, 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)
According to this study, more pronounced knock-knees are also frequently associated with growing pains.
How common is growing pains?
Growing pains are slightly less common in boys than in girls. Their overall frequency is difficult to determine – partly because there are no standardized diagnostic criteria and different age groups have often been studied in this regard.
Depending on the study, it is estimated that up to 37% of children are affected, and in some studies the figure is even higher. If only school-age children are considered, between ten and 20 percent are thought to suffer from growing pains at some point.
How is growing pains diagnosed?
If children of a typical age suffer from the typical pain and no other cause can be found – for example using imaging procedures or laboratory tests – doctors usually make the diagnosis of “growing pains”.
The time factor is often also taken into account: The pain attacks must have been present for at least three months.
Medical history and physical examination
To clarify the pain, doctors first take the medical history of their young patients (anamnesis):
They ask the parents and the affected children (depending on their age) to describe the symptoms in more detail. For example, it is important to know exactly how the pain manifests itself, how long it has existed and how often it occurs.
Other possible questions include whether the pain occurs in the evening or at night, particularly after very physically active days, and whether the child is known to have any underlying illnesses.
The medical history interview is followed by a physical examination. Among other things, doctors examine the musculoskeletal system – the entire musculoskeletal system, not just the areas that often hurt. For example, they test the mobility of joints and check the child’s gait for abnormalities.
Doctors also look for abnormalities in the areas of the body that usually hurt, such as whether the areas are painful or swollen.
Blood tests are also routinely carried out. For example, doctors measure the inflammatory parameters in the child’s blood, such as erythrocyte sedimentation rate and C-reactive protein. Growing pains are not caused by inflammation, which is why the inflammation values are inconspicuous here.
Imaging procedures may also be used, especially X-ray examinations. Here too, the findings for growing pains are unremarkable.
In individual cases, further examinations may be necessary to rule out other causes for the pain (differential diagnoses) – or to prove them. These may include, for example, more extensive blood tests or magnetic resonance imaging (MRI).
Differential diagnoses
There are a whole range of differential diagnoses for growing pains – i.e. other possible causes for 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 cause. This is the most common rheumatic disease in childhood.
Trauma (such as fatigue fractures), inflammation (e.g. of the skeletal muscles) and metabolic diseases (such as rickets) are also possible differential diagnoses.
Here is a summary of a selection of possible differential diagnoses for growing pains:
- Trauma (e.g. stress fractures, overload reactions)
- Rheumatic diseases: e.g. juvenile idiopathic arthritis, collagenoses (connective tissue diseases), fibromyalgia
- Myositis (inflammation of the skeletal muscles)
- Osteomyelitis (inflammation of the bone marrow)
- Septic arthritis (joint inflammation caused by bacteria)
- Rickets
- Vitamin C deficiency
- Vitamin A excess
- Fabry disease (a congenital metabolic disorder)
- Perthes’ disease (rare circulatory disorder of the femoral head)
- leukemia
- lymphomas
- metastases from cancerous tumors (metastases)
- Tumors of the bones or spinal cord
- Restless legs syndrome
Growing pains: progression and prognosis
As unpleasant as growing pains can be, they are benign and nothing to worry about. Parents do not have to fear any consequential damage.
In addition, the symptoms subside on their own or even disappear spontaneously: most children get rid of growing pains after about one to two years.