Let me set the scene….
It’s 9:30 pm on a Thursday night after a long week. You just got your child to bed after another night of tears that required two extensive leg massages and long-winded reassurance that this leg pain is just growing pains and they will feel better in the morning. Now, settled on the couch and finally able to take a breath, you begin asking yourself...
It’s been four straight days—Is this more than just growing pains?
Should we go see someone?
Tomorrow is Friday, who could we even call to get in?
Have I met my deductible?
Did I add milk to the curbside order?
I digress.
Allow me to help you navigate the murky waters of benign nocturnal limb pains, formally known as growing pains.
What are Growing Pains?
Benign nocturnal limb pain predictably rears its ugly head in the early evening into the middle of the night with complaints located in the thighs, back of knees, calves or shins. This cramping or aching pain typically occurs in both legs, does not limit activity during the day and does not cause any limp or limited movement of a specific joint.
This pain can be very episodic, lasting minutes to hours, have varying pain-free intervals from days to months and magically disappears in the morning.
What is the Normal Age for Growing Pain?
These pains can be seen in kiddos as early as 4 years old and can continue up to age 12(ish) with fluctuating length of symptoms and a stronger chance of occurring if immediate family member also experienced “growing pains”.
Why do Growing Pains Happen?
Despite all the advances in the medical field, the cause of benign nocturnal limb pain is still not confirmed. Many different mechanisms have been proposed from an overuse reaction in the muscles, to vitamin D deficiency, to child specific characteristics like pain threshold, anatomical alignment, or hypermobility. This means there is no single test available and is diagnosed by exclusion of other possible diagnoses. The pain typically does not influence activity participation during the day and will not cause any long-term effects.
The real question is …
When Should I Worry About my Child’s Growing Pains?
Probably time to make that call if your child’s pain is:
Caused by a specific injury
Only on one side (only 20% of benign nocturnal limb pain cases)
Persistent over weeks
Increasing in nature
Consistently accompanied by limping, a lump in a muscle, fever, dark colored urine, redness, significant fatigue
Swelling that does not improve the next day
Decreased appetite
What Can be Mistaken by Growing Pains?
There is a long list of differential diagnoses that could be mistaken for benign nocturnal limb pain; however the intention of this post is not to send anyone down a WebMD panic spiral in the middle of the night. There is a great review of evidence including informative charts listed from the first reference articles below. Now kindly close the google search tab(s).
Finally, what to do!
Ok, phew. No need to try to shove an appointment in the last day of the week. Let’s get through this together.
Things to do now:
Draw a warm bath or using a heating pad to increase circulation to the affected area.
Gently massage the painful area as touch is healing, especially yours!
Gently stretch the muscles that surround the painful area.
Over the counter pain medications can be used to decrease symptoms in the short term.
Things to do later:
Consider adding a strengthening and stretching program to your family routine. One of our CTPO Physician Assistants, Chand Shah, runs through a great yoga routine in our video library that you can try with your kiddo at: https://www.ctpomd.com/video-library
For more specific and personalized strengthening or stretching program, schedule a visit with a physical therapist who can evaluate your child to look for opportunities for improvement in your child’s strength, flexibility or movement patterns.
Consider adding Vitamin D supplementation especially in the winter month and if your child happens to be a picky eater.
CTPO is here to help navigate the many resources and opinions that are readily available at our fingertips to make the early years of your child’s life as pain-free as possible.
Now back to that curbside order...
To make an appointment with one of our Physical Therapists, please contact us at (512) 478-8116 or Request an Appointment online!
Resources:
Lehman PJ, Carl RL. Growing Pains. Sports Health. 2017;9(2):132-138. doi:10.1177/1941738117692533
Pavone V, Vescio A, Valenti F, Sapienza M, Sessa G, Testa G. Growing pains: What do we know about etiology? A systematic review. World J Orthop. 2019;10(4):192-205. Published 2019 Apr 18. doi:10.5312/wjo.v10.i4.192