- Thomas JA Lehman, MD
Thomas JA Lehman, MD
- Section Editor — Pediatric Rheumatology
- Professor of Clinical Pediatrics
- Cornell University Medical College
Recurrent, self-limited extremity pains for which the parents, child, and healthcare provider have no explanation are often called "growing pains." Such pains were first described in the medical literature in 1823 . Subsequent publications attributed these pains to "rheumatism," a word synonymous with rheumatic fever at the time [2-7]. Correlations were described with digestive and sleep disorders, loose joints, poor posture, and chronic infection [3,8,9]. By the 1930s and 1940s, growing pains were distinguished from rheumatic fever and other pathologic conditions [5-7]. This distinction remains the focus of the evaluation of children with recurrent limb pain.
Growing pains are benign and usually resolve within a year or two of onset. They must be distinguished from pathologic causes of pain that require additional therapy (table 1).
The epidemiology, etiology, clinical features, evaluation, and management of growing pains in children are reviewed here. The evaluation of children with joint pain and limp is discussed separately. (See "Approach to the child with a limp" and "Evaluation of the child with joint pain and/or swelling".)
There is no consensus definition of growing pains, and, as a result, there are no specific inclusion or exclusion criteria that are uniformly applied to studies of children with complaints of growing pains. The key consideration is that clinicians not dismiss as "growing pains" a significant problem for which intervention may be appropriate.
In this regard, it is best to restrict "growing pains" to the description of children with pain awakening them at night (or from naps) who are otherwise without any manifestation of musculoskeletal problems. In contrast, children with unexplained joint pains that occur in association with activity deserve further investigation, which the child with typical "growing pains" may not.
- Duchamp M. Malodies de la croissance. In: Memoires de Medecine Practique, Levrault FG, Lobstein JF (Eds), Paris 1823.
- Hawksley JC. Race, Rheumatism and Growing Pains. Arch Dis Child 1931; 6:303.
- Seham M, Hilbert EH. Muscular rheumatism. Am J Dis Child 1933; 46:826.
- Hawksley JC. The incidence and significance of growing pains in children and adolescents. J Roy Inst Pub Health 1938; 1:798.
- Shapiro MJ. The differential diagnosis of nonrheumatic growing pains and subacute rheumatic fever. J Pediatr 1939; 14:315.
- Sheldon W. Diseases of infancy and childhood, 5th ed, JA Churchill, London 1946.
- Hawksley JC. Growing Pains in Relation to Rheumatism. Br Med J 1939; 1:155.
- Bennie PB. Growing pains. Arch Pediatr 1894; 6:337.
- Brown LT. Growing pains. A possible mechanical explanation. Boston Med Surg J 1910; 162:424.
- Szer I. Are those limb pains "growing" pains. Contemp Pediatr 1989; 6:143.
- NAISH JM, APLEY J. "Growing pains": a clinical study of non-arthritic limb pains in children. Arch Dis Child 1951; 26:134.
- Brenning R. Growing pains. Acta Soc Med Upsala 1960; 65:185.
- Oster J. Recurrent abdominal pain, headache and limb pains in children and adolescents. Pediatrics 1972; 50:429.
- Evans AM, Scutter SD. Prevalence of "growing pains" in young children. J Pediatr 2004; 145:255.
- Oster J, Nielsen A. Growing pains. A clinical investigation of a school population. Acta Paediatr Scand 1972; 61:329.
- Peterson H. Growing pains. Pediatr Clin North Am 1986; 33:1365.
- Brady M, Grey M. Growing pains: a myth or a reality. J Pediatr Health Care 1989; 3:219.
- Abu-Arafeh I, Russell G. Recurrent limb pain in schoolchildren. Arch Dis Child 1996; 74:336.
- Growing pains. Br Med J 1972; 3:365.
- Baxter MP, Dulberg C. "Growing pains" in childhood--a proposal for treatment. J Pediatr Orthop 1988; 8:402.
- Manners P. Are growing pains a myth? Aust Fam Physician 1999; 28:124.
- Oster J. Growing pain. A symptom and its significance. (A review). Dan Med Bull 1972; 19:72.
- Friedland O, Hashkes PJ, Jaber L, et al. Decreased bone speed of sound in children with growing pains measured by quantitative ultrasound. J Rheumatol 2005; 32:1354.
- Aromaa M, Sillanpää M, Rautava P, Helenius H. Pain experience of children with headache and their families: A controlled study. Pediatrics 2000; 106:270.
- Lavigne JV, Schulein MJ, Hahn YS. Psychological aspects of painful medical conditions in children. II. Personality factors, family characteristics and treatment. Pain 1986; 27:147.
- Oberklaid F, Amos D, Liu C, et al. "Growing pains": clinical and behavioral correlates in a community sample. J Dev Behav Pediatr 1997; 18:102.
- Hashkes PJ, Friedland O, Jaber L, et al. Decreased pain threshold in children with growing pains. J Rheumatol 2004; 31:610.
- Pavone V, Lionetti E, Gargano V, et al. Growing pains: a study of 30 cases and a review of the literature. J Pediatr Orthop 2011; 31:606.
- Halliwell P, Monsell F. Growing pains: a diagnosis of exclusion. Practitioner 2001; 245:620.
- Atar D, Lehman WB, Grant AD. Growing pains. Orthop Rev 1991; 20:133.
- Frazer CH, Rappaport LA. Recurrent pains. In: Developmental behavioral pediatrics, 3rd ed, Levine MD, Carey WB, Crocker AC (Eds), WB Saunders, Philadelphia 1999. p.357.
- Cassidy JT. Progress in diagnosis and understanding chronic pain syndromes in children and adolescents. Adolesc Med 1998; 9:101.
- Macarthur C, Wright JG, Srivastava R, et al. Variability in physicians' reported ordering and perceived reassurance value of diagnostic tests in children with 'growing pains'. Arch Pediatr Adolesc Med 1996; 150:1072.
- American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health, Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics 2001; 108:793.
- Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med 1982; 306:639.