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Growing pains in children

The latest in our series offering evidence-based advice not covered by official guidelines

The latest in our series offering evidence-based advice not covered by official guidelines

Basic rules

• Diagnose innocent leg aches – or ‘growing pains' – on the basis of history and the clinical presentation. Rule out:

– arthritis

– trauma

– orthopaedic diseases

– leukaemia (particularly).

• Suspect other causes of pain if the

child is below three years of age or if the child limps or there are other objective findings.

Epidemiology

• Recurrent pain with no organic cause mainly in the limbs of growing children.

• The prevalence is highest among children aged between three and 11. More than one-third of four- to six-year-olds have growing pains.

• Familial occurrence is common.

Clinical presentation

• Distal foot, knee, leg and thigh are the usual sites of the pain. Upper limbs are rarely affected.

• The pain is often felt symmetrically in both lower limbs or it shifts from one limb to the other.

• The pain is usually present in the evening, during bedtime, or during the night, but not in the morning – in contrast to arthritis causing morning stiffness.

• The pain is felt during rest, but not during exercise.

• The pain lasts half an hour to five hours.

• The age-related variation in the morphology of the lower limbs is not associated with occurrence of growing pains.

• Another cause for the pain should be considered if the child has limping or interruption of play or exercise because of the pain associated symptoms, for example the general condition is affected, continuous unilateral pain, symptoms in the morning or during the day.

Investigations

• If the presentation is not absolutely typical, examine at least:

– complete blood count, to exclude leukaemia

– erythrocyte sedimentation rate.

• X-ray examination is very seldom justified and only if there is some objective local clinical finding.

Treatment

• Self-care by massage, heat and so on, is commonly used.

• Clinical examination to rule out other diseases and explaining the nature of the symptoms to the parents is often all that is required.

• Paracetamol is effective and can be used temporarily.

This synopsis is taken from EBM Guidelines, a collection of treatment and diagnosis guidelines supported by evidence summaries. © Duodecim Medical Publications. Distributed by Wiley-Blackwell. For more information, email freynold@wiley.co.uk or visit ebmg.wiley.com

Child/parent consulting

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