Growing pains in children

"Growing pains" is an old name that has outlived the explanation which gave it. Nobody grows in jerks overnight, and growth has nothing to do with it; the name has stuck simply because it is convenient. Behind it sits something quite specific and very common: a child of nursery or school age complains about their legs in the evening or the small hours, cries, is comforted and rubbed, falls asleep half an hour later, and by morning is charging about as though nothing had happened. It happens to about a third of children and is harmless in itself. But this harmless picture has a double: several illnesses begin in a similar way, and parents are better off knowing how they differ, which is why one section here is given over to exactly that.

What an ordinary night looks like

The recognisable picture is made of several details, and what counts is having them all together rather than one at a time.

• Both legs hurt. Not always equally and not necessarily in the same spot, but one leg tonight and the other tomorrow, rather than the same one for weeks.
• The muscles hurt: calves, shins, the front of the thighs, behind the knee. Not the joint itself.
• The pain comes on in the evening or at night, sometimes wakes the child, and by morning there is no trace of it.
• The child gets up and walks as usual. No limp, no stiffness, no complaints during the day.
• The legs look normal from the outside: no swelling, redness, rash, bruising or tenderness at one particular point.
• The child is otherwise well: growing, gaining weight, no temperature.
• What helps is exactly what would make inflammation worse — rubbing, cuddles, warmth.

The episodes come in waves: several nights in a row, then a month or half a year of quiet. There tend to be more of them after a day full of running about, football and bouncing on a trampoline. It usually starts at preschool age, recurs through the early school years and gradually fades out.

Why the legs hurt if it is not growth

The honest answer is that nobody knows the exact cause. There are several explanations, and they complement each other rather than compete.

The most convincing is that these children have a lower pain threshold. In studies they turn out to be noticeably more sensitive to pressure in other places too, not only in the legs, and migraine and unexplained tummy aches are more common among their relatives. In other words, the peculiarity lies not in the legs but in the way the nervous system handles the signals.

The second is plain muscular overload. An active child piles up in one day an amount of effort an adult would not even think about, and in the evening the muscles answer back. Hence the link with busy days that almost every parent notices.

The third is how the child is built: very bendy joints, flat feet, ankles that roll inwards. None of these is an illness in itself, but legs built that way tire sooner.

What is not on the list is growth itself. Legs do not grow at night or in bursts, and during the spells when a child shoots up the pains do not become more frequent. Nor do they say anything about future height: children who have suffered them end up neither taller nor shorter than their classmates.

What helps in the evening and at night

Strictly speaking there is nothing to treat here — the job is to make the episode easier to bear and to get the child back to sleep sooner.

• Massage and rubbing the legs. This is the most effective thing, and not only because of the touch itself: it matters to the child that an adult is there and is not brushing it aside.
• Warmth: a heat pack through a cloth, a warm bath before bed. Make sure the pack is not hot and does not stay on the skin for long.
• Stretching the calves and the front of the thigh, done during the day rather than in the middle of an attack. This is the one measure that reduced the frequency of episodes in studies; it has to be done regularly, over weeks and months, because the effect builds up.
• Comfortable shoes in the right size with a decent sole. If the child's feet roll inwards or the shoes always wear down on one edge, it is worth showing that to a doctor.
• A painkiller on a bad night. Paracetamol or ibuprofen at a dose for the child's age both work; the choice of medicine and the dose are best checked with a doctor or pharmacist, particularly if the child takes anything else. It is a one-off measure, not a week-long course.
• A calm explanation to the child: the legs are healthy, this will pass, it will be gone by morning. Children who understand what is happening are less frightened, and fright makes pain worse.

One thing separately: children and teenagers are not given aspirin, because it carries a rare but dangerous complication affecting the liver and the brain. Nor is a painkiller needed "just in case" every evening: the pain does not come every night, and the medicine is better saved for the times when it is genuinely needed.

When it is not growing pains

This section is the important one. The diagnosis rests on the whole picture fitting, and every departure from it is worth having a doctor look at the child.

See a doctor if the child:

• always has pain in the same leg or the same spot;
• has pain in the morning or during the day, when walking, running or playing sport;
• has started limping, favours one leg or refuses to walk;
• has pain in a joint — knee, ankle, hip — or a joint that is swollen, hot or hard to straighten;
• wakes with stiff legs that take a while to loosen up;
• has swelling, redness, a rash or bruises that nobody can account for;
• has the pain along with a temperature or night sweats;
• is unusually listless, tires quickly, looks pale;
• is eating poorly, losing weight or has stopped gaining it;
• had an injury before the pain started, or has one tender point on the bone when it is pressed;
• has pain that grows worse week by week instead of coming and going.

Different things sit behind these signs. Most often it is inflammation of a joint, either viral or juvenile arthritis; both are treatable, and the sooner the better. A hot, swollen, exquisitely painful joint with a temperature needs attention the same day: infection inside a joint destroys it within days. Hip or knee pain in a limping teenager can mean the growth plate at the hip has slipped, and that too is a matter of days rather than months.

The rare thing deserves naming on its own: bone pain, always in the same place, building up over weeks, waking the child at night and not settling with an ordinary painkiller, especially with a swelling appearing beside it — that is how bone tumours begin. And leg pain combined with pallor, unusual tiredness, bruising, repeated fevers and enlarged glands is a reason for a blood count, because leukaemia sometimes starts with aching legs. It is rare, and the overwhelming majority of night-time complaints do not end there. But it is precisely because it is rare that it is worth knowing about: the diagnosis is not made on one single sign, but on the picture having stopped being the typical one.

Are tests needed, and when does it all end?

If the picture is typical, the child is well and the examination finds nothing, no blood tests or X-rays are needed — the diagnosis is made from the story and the hands. Even so it is worth going once, not for investigations but so that someone who sees children's legs every day can confirm this is the harmless version. After that, the only reason to come back is a change in the picture.

A useful habit is to note the episodes down: date, which leg, what time, what the day had been like, what helped. Three lines in a phone over a month tell a doctor more than half an hour of recollection in the room, and they also show you whether there is any pattern.

It ends well. The pains go away on their own, usually by adolescence, leave nothing behind, do not damage joints and do not stand in the way of sport. The child needs no restriction on activity, no special diet and no vitamins "for the bones" — unless, of course, a doctor has found a separate reason to prescribe them.

Online consultation

A remote appointment settles exactly the question parents tend to be searching for at two in the morning: whether this looks like ordinary growing pains, or whether something in the picture means the child has to be seen in person and how quickly. The doctor will go through where and when it hurts, what happens in the morning, how the child walks and how they are during the day, look at the legs on camera, explain which painkiller is reasonable and when, and demonstrate the stretches. They will also say whether a blood test is worth doing and when an X-ray makes sense. The signs listed above are not assessed remotely — those need an examination in person, and a hot swollen joint with a high temperature is dealt with the same day.

This material is for information only and does not replace medical advice.