Growing pains (known officially as recurrent nocturnal limb pain) is a general term for non-threatening limb pain in children and is unfortunately poorly understood. However, it is self-limiting, tending to present for short periods of time during a child's growing years and does not have any lasting consequences. But that doesn't mean you won't feel worried when your child wakes in tears at night, complaining of (predominantly) lower limb pain. The most common preconception is that growing pains are caused by a growth spurt; however the most drastic bone growth occurs between the ages of 1 and 2, when a child’s height typically increases by around 13cm, without any associated pain. The most common age groups to suffer with growing pains are 3-5 years and 8-12 years - the most accepted theory is that the muscles and other connective tissues are struggling to keep up with the growth of the bones, causing muscular cramps, spasm and fatigue. Additionally, an overtight muscle can pull on the bone at the site it attaches to, which can be very painful and can even cause mild bone abnormalities; the most common is Osgood-Schlatter disease where a tender, bony lump appears at the bottom of the kneecap.
Growing pains affects boys and girls equally. Your child will often complain of an ache or pain (if they are older, they may describe an intense cramp) over a broad area, notably the shins, calves, thighs and ankles. The pain is nearly always felt in the evenings and at night. What isn’t fully understood is the occurrence of growing pains. One in 4 children will suffer with them; for some it is a one-off episode lasting a couple of weeks, for others it can come back every year lasting a few months.
How do I know if my child has growing pains?
The major signs and symptoms that suggest your child may have growing pains are:
- the pain is felt on both sides,
- it doesn’t affect their ability to walk or weight-bear
- pain is present in the evenings and at night.
It is very distressing for parents to have their child complain of pain and is easy to worry that you are missing something serious. Whilst it is always important to seek medical advice from a GP or an osteopath if your child is complaining of persistent limb pain, it is also worthwhile asking yourself the following; does my child complain of pain in the day? Are they avoiding usual activities and sports? Are they limping? Do they appear ill? Is there redness and swelling at any of the joints? If the answers are no, the likelihood is that they are experiencing growing pains.
What could cause growing pains?
Whilst the true cause isn’t known, there does seem to be a link between hypermobility in children and growing pains. Hypermobility is when the joints are more flexible than other peoples, usually due to increased elastin and decreased collagen within the ligaments. You may notice your child has flat feet or appears to be ‘double-jointed’, e.g. has bendy elbows, fingers and knees. You may also notice your child falls over more than others. Whilst there is no cure for this, there are treatment options, with the emphasis on building muscular strength and encouraging joint stability. Sometimes orthotics and joint braces (e.g. ankle supports) are used to help re-align and support the joints. It is important to seek medical advice if you are concerned your child may be hypermobile, as they may be at an increased risk of sprains and strains. Your GP or a local osteopath can help with diagnosis and management of this condition.
Growing pains also tend to be present in more active children and there is often a direct link with levels of activity in the day and complaints of growing pains in the night.
My GP says my child has ‘growing pains’ – what should I do?
Whilst there is no ‘cure’ for growing pains, there is plenty you can do to help manage your child’s discomfort:
- Warmth applied to the muscles (with a hot water bottle or heat pack) helps by increasing blood flow to tight muscles, reducing tension and fatigue. Although it has a less direct effect, warm baths often help relieve discomfort and whilst there is no official research, many patients report the use of Epsom salts as helpful in reducing limb pain (and it certainly won’t do any harm).
- Massage – this can be very soothing to your child when they wake in pain, so if you have the energy, a firm (or even gentle!) massage along the muscle should help to reduce the ache.
- Keep a diary of your child’s activities and look for the link between this and the nights they complain of pain. To prevent the pain from starting, give your child paracetamol or ibuprofen before bed.
- Stretches – if your child is old enough, it is really worthwhile encouraging them to get into a good stretching habit following exercise. If they are still very young (or you apprehend some resistance to stretching themselves!), you can help do this for them – namely the hamstring and calf muscles. Additionally a session with an manual therapist (osteopath/physiotherapist) can help, as they can isolate tighter areas and stretch them accordingly.
- Check that your child’s footwear is supportive enough. Generally trainers are best (particularly for exercise, obviously!) as they often have an inbuilt inner foot arch, extend further up the ankle joint and allow tighter fastening through Velcro or laces.
- If you are concerned about hypermobility or any other underlying musculo-skeletal concerns in your child, take them to a specialist for assessment.
When should we go back to the doctor?
Growing pains will ease naturally with time, with no ill effects to the musculo-skeletal system, although the length of time can vary drastically form child to child. However, look out for the following and go back to the doctor if you notice;
- Joint redness and swelling
- An inability to weight-bear, particularly in the morning
- Pain in just one leg
- Avoidance of usual play and sports
- Complaints of persistent pain in the arms and back
- Loss of appetite, weight loss and fever
Sian Smith, Registered Osteopath at Bridge to Health in Ealing and Uxbridge
Contact at: firstname.lastname@example.org or by tweeting at @Bridge_ToHealth