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Growing pains: a noninflammatory pain syndrome of early childhood

Nature Clinical Practice Rheumatology volume 4, pages 542–549 (2008)Cite this article

Abstract

The term 'growing pains' has been used for almost 200 years to refer to the often severe, generally bilateral lower-extremity nocturnal pains experienced by up to one-third of all children at some time during early childhood. No clear mechanism has yet been identified that explains these pains, but there is an increasing body of evidence indicating that several factors, individually or in combination, might be responsible for this phenomenon. These include mechanical factors, such as joint hypermobility and flat feet, decreased pain thresholds, reduced bone strength, and emotional factors involving the patient's family and other social stressors. Correct diagnosis of growing pains requires a thorough patient history and physical examination. The diagnosis can be safely established without unnecessary laboratory investigations or imaging; however, identification of one or more clinical cautionary signs, such as unilateral pain, morning stiffness, joint swelling and systemic symptoms (e.g. fever, weight loss and malaise), should trigger an extended evaluation to exclude other more serious conditions that might also present with limb pain. Once the diagnosis has been established, conservative management, using symptomatic pain medications, massage and other supportive measures, should be employed until the syndrome self-resolves with time.

Key Points

  • The term 'growing pains' is a misnomer, describing a common, benign, noninflammatory pain syndrome of early childhood that usually resolves with time, without specific treatment

  • Growing pains is a clinical diagnosis based on characteristic features of nonarticular, bilateral pain, mainly in the lower extremities, that occurs mainly in the evening or night with resolution of pain by morning and a normal physical examination; patients fulfilling these criteria do not need to undergo further evaluation

  • Patients with features that do not fit the typical description of growing pains need to be evaluated carefully for an alternative diagnosis

  • While the etiology is still unknown, factors that influence growing pains include overuse, decreased pain threshold, decreased bone strength, anatomical or mechanical features and family dynamics

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Infectious Disease and Rheumatology, RM Lowe is a Pediatric Rheumatology Fellow in the Rainbow Babies and Children's Hospital–Cleveland Clinic Joint Program, Cleveland, OH.,

    Robert M Lowe

  2. Department of Rheumatic Diseases, PJ Hashkes is the Section Head of Pediatric Rheumatology at the Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, OH, USA.,

    Philip J Hashkes

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  1. Robert M Lowe
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Correspondence to Philip J Hashkes.

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The authors declare no competing financial interests.

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Lowe, R., Hashkes, P. Growing pains: a noninflammatory pain syndrome of early childhood. Nat Rev Rheumatol 4, 542–549 (2008). https://doi.org/10.1038/ncprheum0903

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