Growing Pains
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
- No specific joint involvement
- Often occur after having had an active day
- Occur at night time
- 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?
- Infection
- Cellulitis
- Abscess
- Septic Arthritis
- Osteomyelitis
- Bone Injury or Abnormality
- Toddler’s Fracture
- Slipped Capital Femoral Epiphysis
- Legg-Calve-Perthes Disease
- Osgood-Schlatter’s Diseae
- Sickle Cell Disease
- Abuse
- Oncologic Process
- Osteosarcoma
- Ewing’s Sarcoma
- Leukemia
- Osteoid Osteoma
- Giant Cell Tumor
- Histiocytosis X
- Osteochondroma
- Rheumatic Process
- Juvenile Idiopathic Arthritis
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
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