Google ‘leg pain in children’ and you are instantly catapulted into the realms of arthritis and leukaemia. If you go for ‘growing pains’, you find infuriatingly vague information. Dr Jinan Harith Darwish explores the subject for us.
Children every so often wake up in the dead of night weeping in pain and grasping their lower legs, even when they have been well and energetic during the day. The episodes can be dramatic and interrupt sleep for the whole family.
This experience is common and parents can be reasonably spooked by their children’s baffling symptoms. Growing pains affect up to 37 per cent of children to varying degrees. The pains usually affect healthy children between the ages of three and 13. Nobody knows why they occur, but one thing is apparent: it has nothing to do with growth. Children grow maximally as babies or during adolescence; however, these are not the periods when they have the growing pains. It’s a total misnomer. The term has stuck because it is just easier to remember than its medical name, ‘benign idiopathic nocturnal limb pains of childhood’. Growing pains is really just a label covering all sorts of uncertainties.
The pain usually appears late in the day or at night, often waking the child. The duration ranges from minutes to hours. The intensity can be mild or very severe. By morning, the child is usually pain-free. Pains are intense and crampy, affecting both legs symmetrically though not always at the same time, usually the calf, shins or ankles, and are not limited to the joints. However, they will not cause the child to limp.
We know the pains are not linked to dietary deficiency or growth problems. They seem more common in active children and children with hypermobile joints and they tend to run in families.
A whole raft of other illnesses can be confused with growing pains. In fact, pain in the limbs of young children can be a sign of serious problems, including chronic rheumatic disease, inflammatory muscle disease, childhood arthritis, leukaemia and sepsis. It is important to know that, in all these cases, there will be other indicators that the child is not all right. Nevertheless, early diagnosis of some of these conditions can make a big difference to outcomes, so it’s in no way a bad idea to rule things out. Even without other symptoms, there is no shame in taking a child with growing pains to the paediatrician.
Your child should definitely see a doctor if there is any joint swelling or the pain is in only one leg or they are experiencing pain in the arms or back, fever, loss of appetite or weight loss. This is also true if the pain occurs every night and there is a reluctance to walk or limping, especially in the morning.
The key intervention is to understand the natural benign course of the growing pains, thus decreasing anxiety and fear. Soothing, local massage therapy during pain episodes or analgesics can be used. Some children need to use medications, especially paracetamol and non-steroidal anti-inflammatory drugs like Ibuprofen. Keeping a diary could help establish what activities could be triggers. Often parents can predict when the child will have pain – on days of increased activity or when the child is more moody. Prophylactic pain relief is recommended if you can predict an episode. Other interventions shown to be effective in small controlled studies include in-shoe inserts such as triplane wedges or orthotics, especially in children with pronated foot posture, and a muscle-stretching exercise programme. If all else fails, take consolation in the fact that growing pains won’t go on forever.