When a diagnosis of ‘Growing Pains’ Masks Arthritis In School Children

Pediatric Specialist Warns On Things That Go Ouchie

New York, NY—August 30, 2004 

Your son or daughter's sharp leg pains in the middle of the night can frighten child and parent alike and raise the question about whether the child should go to school in the morning or go to the doctor. Most often the pains are gone in the morning and if called the physician will tell you it was 'just growing pains.'

But what if the pain is not gone in the morning or a parent is not sure they are just routine "growing pains?" How do you know whether "growing pains" might actually be early sign of arthritis or another rheumatic disease?

"Nearly 300,000 children in the U.S. suffer from rheumatic diseases such as juvenile arthritis (JRA), fibromyalgia, chronic fatigue, systemic lupus erythematosus, scleroderma or Kawasaki disease," according to Thomas J.A. Lehman, MD, Chief, Division of Pediatric Rheumatology for the Hospital of Special Surgery in New York City.

"Children do have growing pains; in fact they are fairly common. But unfortunately, many children with serious problems are misdiagnosed with growing pains for weeks or even months. Children with arthritis are often first noticed because they walk abnormally when they wake up in the morning, but since 'they get better in a few minutes,' no one is very concerned," Dr. Lehman said.

According to Dr. Lehman, parents need to know that:

  • Growing pains never occur during the daytime.
  • No matter how severe the pain at night, children with growing pains are always fine the next morning.
  • Any child with pain when they wake up in the morning or pain during the day requires a careful medical evaluation.

Dr. Lehman says growing pains typically occur in young children between the ages of three and eight years. The child will wake up suddenly from a deep sleep complaining that his or her legs hurt. Parents become aware of the problem because the child is crying in bed. Most often the episode occurs a few hours after the child has gone to sleep but it can occur in the middle of the night. Typically, the child will point to the front or back of the knee or the muscles just above the knee. The pain will usually disappear with 10 or 15 minutes of gentle massage and be completely gone in the morning.

If the pain goes away and the child is fine in the morning, a trip to the doctor is not usually necessary, but any child with persistent pain or pain during the day should be medically evaluated.

When you take your child to the doctor because you are concerned about their pain, doctors need to know certain information:

  • What is the quality of the problem: is it a sharp pain or a dull ache?
  • What is the exact location of the problem?
  • How long has the pain been going on and how did it start?
  • Is it getting better over time, or worse?
  • What lessens the pain, what makes it worse?
  • Is the pain in the joint (where the bones come together) above or below the joint?
  • Is the child in pain without being touched, or does it hurt only if you squeeze?
  • Is it one joint that hurts or several?
  • Is the area hot or warm to the touch?
  • Is it red or obviously swollen?
  • Does the child have other findings such as a rash, bumps, etc?

"Proper evaluation consists of taking a careful history and doing a complete physical exam. In the hands of an experienced physician, this is often sufficient to establish diagnosis. Further testing may be ordered only to confirm the diagnosis and assure that there is nothing else wrong," said Dr. Lehman.

Dr. Lehman, author of "It's Not Just Growing Pains," published by Oxford University Press, is also Professor of Clinical Pediatrics at Weill Medical College of Cornell University.

For more information on helping children with Musculoskeletal Disease contact National Institute of Arthritis and Musculoskeletal and Skin Diseases at http://www.niams.nih.gov; The Food and Drug Administration at http://www.fda.gov; The American Academy of Pediatrics at http://www.aap.org; The American College of Rheumatogy at http://www.rheumatology.org/index.asp and the American Academy of Orthopedic Surgeons at http://www.orthoinfo.aaos.org. Dr. Lehman provides more information about the childhood rheumatic diseases at www.goldscout.com

About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology by U.S. News & World Report (2007), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In the 2006 edition of HealthGrades' Hospital Quality in America Study, HSS received five-star ratings for clinical excellence in its specialties. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Medical College of Cornell University. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

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