Growing pains

In brief

Growing pains are episodes of leg pain that occur in some healthy children, usually in the evening or at night, and generally affect both legs. They are harmless, go away on their own and do not damage bones or joints. However, if the pain is always in the same spot, causes a limp or appears in the morning, it is important to see a doctor to rule out other causes.

Typical age

Between 3 and 12 years, although they can appear outside this range

Also known as

Benign nocturnal limb pains · Benign recurrent leg pain of childhood

What they are

Growing pains are recurrent episodes of leg pain that appear during childhood, especially at pre-school and school age. They usually affect both legs, particularly the thighs, the calves or the area behind the knees. They are estimated to affect about 10–20% of children, although the figure varies between studies and the criteria used.

Despite the name, there is no evidence that this pain is directly caused by bone growth. Its origin is not fully understood. In some children it may be related to the physical activity built up during the day, sensitivity to pain or other individual factors.

The pain usually appears at the end of the day or during the night, may wake the child and is gone by morning. There are often pain-free days between episodes. Children are usually well, keep up their normal activities and do not limp or have any limitation during the day.

The typical pattern affects both legs, although the intensity may differ between them. When the pain is persistent, always in one particular place or comes with other symptoms, another cause needs to be considered.

Signs parents may notice

The most typical symptoms are:

• Pain in the thighs, calves or behind the knees.
• Discomfort that appears in the evening, at bedtime or during the night.
• Episodes that may wake the child and disappear by morning.
• Pain that usually affects both legs, though not always equally.
• Pain-free days between episodes.
• Relief with gentle massage, warmth or comforting.
• Child otherwise well, with no fever, swelling or redness.
• Able to walk, run and play normally during the day.

When to see a specialist

It is worth asking for a medical assessment if the episodes happen often, raise doubts or disturb the child’s sleep. An examination can confirm that the pattern fits growing pains and rule out other causes.

See a doctor especially if you notice any of these signs:

• Pain that always affects the same leg.
• Pain at a specific point on a bone or joint.
• Limping, difficulty walking or refusing to put weight on the leg.
• Pain in the morning, during the day or getting gradually worse.
• Swelling, redness, warmth or reduced movement.
• Fever, unusual tiredness, weight loss, paleness or other general symptoms.
• Pain that becomes increasingly severe, persistent or does not go away between episodes.

When is it urgent?

Seek urgent assessment if the child has fever with severe pain in a limb, a swollen or hot joint, a sudden inability to walk or put weight on the leg, or severe pain that starts suddenly. These symptoms may indicate an infection or another problem that needs prompt attention.

How they are diagnosed

Diagnosis is mainly based on the medical history and physical examination. There is no specific test that confirms growing pains.

The specialist will ask when the pain appears, how long it lasts, where it is, whether it affects one or both legs and whether it goes away completely by morning. They will also ask about physical activity, sleep and any other symptoms.

The examination looks at how the child walks, joint movement, tenderness of bones and muscles, and any swelling or other signs that might point to a different cause.

When the pattern is typical and the examination is normal, X-rays and blood tests are usually not needed. If there are warning signs, localised pain or diagnostic doubts, the doctor may request imaging or blood tests depending on what is suspected.

Treatment

Non-surgical treatment

Growing pains do not need specific treatment and usually improve with simple measures to ease the discomfort.

1. Gentle massage

Gently massaging the legs for a few minutes can help relieve the pain and comfort the child.

2. Local warmth

A warm blanket or a heat pack wrapped in a towel may bring relief. Avoid excessive heat and take care to prevent burns.

3. Gentle stretches

If the child tolerates them, gentle leg stretches can be done. They should not cause pain or be forced.

4. Physical activity and rest

There is usually no need to limit play or sport if the child is well and has no discomfort during the day. A balanced level of physical activity and good rest are recommended.

5. Pain medication

If the discomfort is significant, the paediatrician may recommend a painkiller suited to the child’s age, weight and medical history. Medication should not be given repeatedly without checking with a doctor if the pain persists or changes.

Insoles, casts and surgery are not indicated for typical growing pains.

Surgical treatment

Growing pains do not need surgery. No operation is indicated to treat them.

If the pain persists, is always in the same place or comes with a limp or other warning signs, the diagnosis should be reviewed to identify the real cause of the discomfort, if there is one.

Outlook and recovery

Growing pains usually have a good outcome. Episodes may come and go for months or years, but they tend to disappear with age and leave no lasting effects.

• During an episode: gentle massage and warmth can ease the discomfort within minutes.
• The next day: the child is usually well and able to walk, run and play normally.
• School and sport: there is usually no need to stop normal activities if there is no pain during the day and no other symptoms.
• Follow-up: if the episodes change pattern, occur during the day, cause a limp or come with other signs, a new assessment is needed.

Although the outlook is good, it is important not to automatically put any leg pain down to growing. A proper assessment makes it possible to recognise the harmless pattern and detect the cases that need further investigation.

This page is for general information and does not replace an assessment by a specialist. If you are worried about your child's foot, talk to their paediatrician or book an appointment.