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The Informed Parent

Growing Pains

by Pediatric Medical Center
Published on Jan. 01, 1997

My 2 1/2-year-old daughter occasionally complains of aching in her knee joints, usually in the middle of the night. These complaints have been occurring every couple of weeks for about the past year and whatever discomfort she experiences apparently goes away within 10 or 15 minutes. She is a healthy and active girl who does her share of normal running and jumping around. Only twice have I given her tylenol for the situation, mostly to placate her; the aches are gone quicker than the tylenol can take effect. In the back of my mind I wonder if these symptoms could be anything other than "growing pains"? Have you any comments or information?

The diagnosis of "growing pains" must be made with some caution. There is no question that this entity does exist and is very common. But as you have alluded, other conditions can cause similar complaints.

"Growing pains" have very characteristic qualities. They usually occur at a time of rest, most commonly at night, and are not related to the patient's activity level during the day. The pains occur sporadically in cluster of uncomfortable nights intermixed with long periods with no symptoms at all. Children are usually affected from age 2 to 12 years, with a peak incidence from 3 to 7 years. There is no joint swelling, tenderness, redness or heat.

In fact, if the patient is old enough and you question him carefully, you will find the pain is not in the joint but in an ill-defined area at the ends of the long bones. This area borders on the joints and thus the child relates the pain to the joint itself. The joint seemingly involved has a full range of motion. Furthermore, the child has no fever and otherwise appears well. The discomfort is relieved by rubbing the area or by the application of heat. Occasionally, tylenol preparations are of help but as you shrewdly observed, the pain leaves before the analgesic can work.

It is thought the pains are caused by the stretching of the muscles and tendons due to a time of rapid linear growth. The pain receptors in these "stretched" areas are activated through a normal nervous system warning mechanism. If the receptors could perceive that the stretching was due to normal rapid growth and not trauma, I'm sure they would remain silent. One could argue that it is the patient's low pain threshold and not the aberrant activity of the body's warning system, but it really does not matter. When a parent is confronted with a crying toddler at 2 a.m., the physiologic considerations are of little import. Since we cannot control how fast our children grow taller, there is truly no prevention for this common entity.

The conditions that might be mistaken for growing pains are rare in the growing pain age group.

Juvenile Rheumatoid Arthritis, trauma, bone and joint infections, synovitis (inflammation of the lining of a joint), abnormalities in blood calcium and sodium, bone tumors and blood malignancies could be confused with the growing pain syndrome if the parent does not carefully assess the child's signs and symptoms. Careful assessment entails a thoughful and alert examination of the area or areas of pain and the application of the hallmarks of this condition I listed in the second paragraph of this article.

I stress the alert assessment because these pains usually occur at night when the observing parent might be less than fully concentrating. The above listed conditions will not usually fit the described characteristics of growing pains. That is, the symptoms may be more persistent or follow extreme exercise. The joint may be swollen with a limited range of motion, there may be severe muscle spasm (cramps), the child may have a fever or generally not feel well.

If your child's symptoms do not fit the usual signs and symptoms of "growing pains" WITHOUT QUESTION, it is imperative you discuss the problem with your child's physician.

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