Growing pains

Common leg pains at night in young children. Not caused by growing, and the point of this entry is what they are not.

What it is

Growing pains affect around a third of children between three and twelve. The name is wrong: they have no relationship to growth spurts, and growth itself is not painful.

The pattern is specific and reassuringly consistent: aching in both legs, in the muscles rather than the joints, in the evening or waking the child at night, with the child completely well and running about normally the next day.

The reason for the entry is not the condition, which needs no treatment. It is the differential. Several serious conditions present as leg pain in a child, and growing pains is a diagnosis of exclusion made by pattern.

If the pain is on one side, involves a joint, is present in the morning, causes a limp, or comes with any systemic symptom, it is not growing pains.

Signs you might notice

Growing pains: both legs, muscles rather than joints, evenings or night, resolving by morning, child otherwise entirely well.

Not growing pains, and needing assessment: pain in one leg only; joint swelling, redness or warmth; a limp; pain in the morning or lasting into the day; fever, weight loss, night sweats; a lump; back pain; or a child who has stopped using a limb.

Persistent bone pain, particularly at night, with fatigue or bruising, needs prompt assessment; leukaemia can present this way.

Morning stiffness lasting over 30 minutes suggests juvenile idiopathic arthritis.

How it can affect day-to-day life

Parents are frequently reassured too quickly, and occasionally reassured wrongly. The pattern is what distinguishes benign from serious, so describing it precisely is what a clinician needs.

Genuine growing pains respond well to comfort measures and to being taken seriously. Children are not making it up.

Recurrent night pain that disturbs a household is worth managing rather than dismissing, even when benign.

Supporting someone well

Check the pattern. Both legs, muscles, evening, gone by morning, child well: reassuring. Anything else: get it assessed.

Massage, warmth and paracetamol at the time help.

Do not restrict activity; there is no need.

Keep a simple diary if it is frequent. It helps confirm the pattern and reassures everybody.

Get any limp assessed. A limping child is never normal.

Take a child who stops using a limb seriously and urgently.

Where to get help

A GP for any atypical feature, a limp, joint swelling, or systemic symptoms.

Arthritis UK have information on childhood joint conditions.

Persistent bone pain with fatigue, bruising or pallor needs same-week assessment.