Growing Pains

Growing Pain

 

We have discussed previously how working in the Peds ED is like being tasked with finding the rare, life-threatening needle in the haystack of the benign and common.  In order to do this, it requires us to maintain a baseline paranoia helping us to remain ever vigilant.  It also helps to have keen eyesight for subtle red flags. Recently we discussed osteosarcoma, but the child with leg pain will much more likely have Osgood-Schlatter’s Disease or “growing pains.”  It is quite tempting to reflexively diagnose “growing pains” in the young child who is “growing” and has “pain,” but otherwise appears well.  What are the signs that should cause us to pause before we pronounce Growing Pains as the diagnosis?

 

Growing Pains: Not due to growing

  • The cause of growing pains is still debated, but it does not appear to be due to rapid growth. [Mohanta, 2014]
  • Peak age for growing pains is 4-14 years, which is not the peak age for bone growth.
  • The sites of typical pain do not match the areas of maximal growth.

 

Growing Pains: Diagnosis

  • 10-20% of children are affected by growing pains. [Mohanta, 2014]
  • Characteristics of Growing Pains:
    • Occur at night time
      • No daytime symptoms or findings
      • May awaken some at night.
      • May cause crying. [Asadi-Pooya, 2007]
    • Intermittent
      • Occur only once or twice a week
      • Episodes last 30 to 120 min.
      • No consistent pattern
      • Pain free in between episodes
    • Poorly localized
      • No specific joint involvement
        • Usually calf, anterior shin, and or popliteal fossa area.
      • No objective findings on exam
      • No other physical complaints
    • Often occur after having had an active day

 

  • In truth, the diagnosis is one of exclusion! [Asadi-Pooya, 2007]

 

Growing Pains: Consider the Badness!

If growing pains are benign, but are a diagnosis of exclusion, what are some conditions that need to be considered first, before considering growing pains?

 

Growing Pains: Red Flags for Badness

Looking for the dangerous needle in the haystack of benign conditions? Be alert for:

  • Daytime Pain
  • Systemic Symptoms
  • Persistent Pain
  • Localized Pain
  • Only One Limb Involved
  • Joint Involvement
  • Limping
  • Abnormal Exam
  • If any of these are present, you should have a low threshold for investigating further.
  • The diagnosis of growing pains, however, does NOT need laboratory or radiographic testing. [Asadi-Pooya, 2007]

 

Growing Pains: Treatment

Symptomatic treatment… which, again, doesn’t work for osteosarcoma… so be vigilant!

  • Analgesics (NSAIDs)
  • Massage
  • Routine lower extremity muscle stretching twice a day

 

References

Mohanta MP1. Growing pains: practitioners’ dilemma. Indian Pediatr. 2014 May;51(5):379-83. PMID: 24953579. [PubMed] [Read by QxMD]

McCarville MB1. The child with bone pain: malignancies and mimickers. Cancer Imaging. 2009 Oct 2;9 Spec No A:S115-21. PMID: 19965301. [PubMed] [Read by QxMD]

Asadi-Pooya AA1, Bordbar MR. Are laboratory tests necessary in making the diagnosis of limb pains typical for growing pains in children? Pediatr Int. 2007 Dec;49(6):833-5. PMID: 18045281. [PubMed] [Read by QxMD]

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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2 Responses

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