"My legs really hurt!” How many times has a caregiver heard this complaint from a child? Perhaps you have had leg pain from exercise, arthritis, strained ligaments, or other reasons, and you know that it usually disappears with some rest and time.

So should a caregiver be concerned when a child has leg pains? When should the parents be notified? Is it bad enough to send the child to the nurse, or even to the hospital?

Caregivers may encounter children between ages three-five who are experiencing growing pains in their legs or other limbs, and in general this condition is not serious. Growing pains are fairly common. About one out of three children experience growing pains at least once in their life.

Both boys and girls experience growing pains. With most children, the pains affect both legs and consist of on-and-off pain, with possibly days or even weeks of no pain. The pains occur primarily at night and can be severe and may awaken the child from sleep. Pain from fatigue may resemble growing pains, but fatigue pain usually disappears after rest.

The child typically describes the pain as localized in the lower leg (usually the calf), thighs, or behind the knees. The pains can be felt in any limb, but are usually most pronounced in the knees and legs.

While these aches are called ‘growing pains,’ there is no firm medical evidence to show that the cause comes from the child’s growing bones. The most likely causes are the aches and discomforts resulting from the jumping, climbing, and running that active children do during the day. The pains can occur after a child has had a particularly athletic day.

Growing pains usually occur in very active children. Children run, jump, hop, and climb all day long. Then, usually at nighttime, when they are in bed and quiet, they begin to notice the aches and pains in their limbs. And that pain can be significant.

So what causes growing pains? Bones and muscle grow at different rates. During a growth spurt, the pains tend to come more often and may be more severe because bone growth and muscle growth are temporarily out of sync.

Two common growth spurts usually begin between the ages of three-five and then between eight-12. It usually is within these two age groups that growing pains are most common. It is interesting to note that growing pains occur less frequently in those children that are less active.

Growing pains, in general, are mild and do not last long. So how is a caregiver supposed to know whether a child has growing pains or some other problem that may need medical attention? While caregivers should never attempt to diagnose growing pains or any other condition, it is important to recognize signs that could indicate a need for medical attention.

Growing pains appear in the muscles, not the joints. Children may report pains behind the knees, in the front of their thighs, or in the calves.

Examine the painful area. Growing pains will show no redness or swelling. Childhood arthritis, joint injuries, and other significant medical problems will usually have some visible clue present.
The limb or joint of a child with growing pains will look and feel normal, and the child will be able to move it normally. There rarely is a limp involved.

Another sign is pain. The child with a serious bone, joint, or muscle problem generally will not want you to touch the area because it is painful; however, children with growing pains like to have the area massaged to help relieve the pain.

The child should be seen by a health care provider if any of the following develop as these symptoms are not due to growing pains.

• Fever, redness, and swelling in one or more joints
• Persistent pain or pain in the morning
• Pain associated with a particular injury
• Limping
• Weakness
• Tiredness
• Unusual rashes
• Loss of appetite
• Development of any unusual behavior

Caregivers and parents need to be aware that the ache from growing pains may mimic Grandma’s arthritis, but the pain a child is experiencing may have a totally different cause. As with any unusual or recurring pain or symptom, if there is any suspicion that the pain may not be a result of growing pains, or if there is something about the condition that makes the caregiver or parent feel uncomfortable, the child should be seen and treated by a health care provider.

With growing pains, encourage the child to continue with normal physical activities. Do not tell the child that pain is due to growing or physical activity because this information may make the child afraid of both.

An ice pack wrapped in a towel and applied for 10 minutes can help with the pain. Doing gentle flexibility movements and leg stretches, and limiting physical activity for an hour or more prior to bed can minimize symptoms.

The child’s doctor may suggest that parents manage the child’s pain with an over-the-counter medication such as ibuprofen or acetaminophen. (Aspirin is not recommended for children under age 19 because of the risk of Reye’s syndrome.) If medication is to be given while the child is in your care, you must adhere to your program’s policies and procedures.

Leg pain is a potential concern for anyone who cares for children. When the signs point to growing pains, with no symptoms that suggest it might be from another cause, everyone can breathe a sigh of relief knowing that it will pass with time. But, just as with any other issue involving children’s health, if a caregiver has any suspicion that another cause may be involved, be mindful of the old adage that “it is better to be safe than sorry.”

Joe Knight
Family Practice Assistant and Writer, Fresno, California

About-Pediatrics, pediatrics.about.com/od/weeklyquestion/a/04_leg_pains.htm

Kids Health, www.kidshealth.org/kid/ill_injure/aches/growing_pains.html

Penn State, westmoreland.extension.psu.edu/Family/Toddler/tt2001_Issue3.htm

University of Toronto, www.utoronto.ca/kids/growpain.html