Primary Care

Pediatric Pearl: Defining "Growing Pains"

11/23/2022

  • The Research

    The authors of a recent study in Pediatrics perform a scoping review of the literature on the somewhat nebulous topic of growing pains. In an effort to better define growing pains, the authors searched eight electronic databases and six disease classification systems and included any peer-reviewed English articles or diagnostic codes that included growing or growth pains. They examined each of the 145 studies, as well as the ICD-10 and SNOWMED codes, for its definition of the condition.

    The Results

    No single characteristic was cited in more than 50% of the definitions. The most consistent features included lower limb pain (referenced in 50% of the definitions), evening or nighttime pain (48%), episodic or recurrent pain (42%), normal physical exam findings (35%), and bilateral pain (31%). They conclude that their scoping review does not provide any consistent features of growing pains, and that clinicians and researchers should be cautious in drawing conclusions based upon what they consider the condition to be.

    Most clinicians in general practice have seen what we consider to be growing pains and that the condition is real and common.

    The Bottom Line

    In my view, any definition of growing pains requires four criteria:

    1. The pain must involve both legs at some point (it cannot be localized only to one area or one leg).
    2. The pain must occur predominantly at night.
    3. The pain cannot interfere with regular daytime activity.
    4. The physical exam must be normal, and in particular, not involve swelling or point tenderness.

    Any leg pains that do not meet these criteria require further investigation. Although far less scientific than this scoping review, my four criteria have served me well in my clinical practice.

     

    Reference:

    O'Keeffe M, Kamper SJ, Montgomery L, et al. Defining growing pains: a scoping review. Pediatrics. 2022;150(2):e2021052578. doi:10.1542/peds.2021-052578

    Scott T. Vergano, MD is a pediatrician in the Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA