We’re all familiar with the term “growing pains,” but what exactly are they? Often used to describe childhood aches and pains, the term itself can be confusing, as growing pains often do not occur during growth spurts.
Growing pains are harmless, self-resolving, non-inflammatory pains in the extremities that occur later in the day and may wake children from sleep. Despite their name, growing pains are not actually caused by growth, and they do not affect a child’s growth. Classic growing pains occur in younger children, up until around age 10. These pains most commonly affect preschool and school-aged children and occur slightly more frequently in girls than in boys.
In a typical scenario, a child goes to bed and wakes up an hour or so later crying because of pain around the lower thighs, behind the knees, in the shins, and calves, but without redness, warmth, or swelling associated with injury or inflammation. They may ask to have the area rubbed to make it feel better and, eventually, they fall back to sleep. The next morning, they’re fine. They go to school and engage in their usual activities. The next night, the child goes to bed and again wakes up crying in pain.
It can be frightening for parents and upsetting for children, especially if it goes on for a couple of weeks. Despite the disruption, growing pains are usually a normal part of childhood and generally not cause for alarm.
A different type of pain that affects older children is also often called “growing pains.” These pains occur in older kids and are thought to come from the demands placed on an active child’s muscles throughout the day from playing a sport, running, climbing, and jumping. This type of pain is often felt after activities or later in the day, but rarely wakes children up from sleep.
For very active children, some aches and pains are normal, especially if they spend a lot of time playing sports. If a child or teen participates in soccer 12 hours per week or takes ballet lessons and dances 15 hours weekly, some soreness can be expected. If pain arises from excessive athletic activity, we often counsel parents to persuade their kids to listen to their bodies and take a break, especially if they start feeling aches and pains. The American Academy of Pediatrics recommends that children limit participation in a particular sport to 5 days per week to avoid pains from overuse.
Although common in children, doctors do not know a specific cause. Growing pains often occur at the end of a more active day, so they may be related to an overuse injury and/or decreased bone strength. Growing pains may also occur in children with lower pain thresholds.1
Growing pains usually begin between the ages of two and 12. They occur primarily in both lower extremities (especially the calves and thighs) and are frequently described as being deep and crampy. The pain occurs in episodes – typically in the evening – and may frequently wake the child up from sleep. There are no objective signs of pain, such as redness, swelling, or warmth. These pains generally resolve quickly, and in the morning, children are fine and able to resume their normal activity.
It is important for doctors to distinguish these pains from other pain that may deserve further investigation. Children with growing pains show no visible signs of illness or injury, and they do not have fevers, rashes, weight loss, joint swelling, or limping. Any child exhibiting any of these symptoms should be evaluated promptly by a doctor to determine whether there is another cause of the pain.
When the cause of discomfort is indeed growing pains, the good news is that they eventually go away and do not interfere with growth. In the meantime, parents can help their child feel better with gentle massage, a heating pad, and a dose of children’s acetaminophen or ibuprofen. Muscle strengthening and stretching exercises may be helpful for more chronic pain, although this has not been well studied. Above all, the pain should not be allowed to disrupt a child’s normal daytime activities. Stopping daytime activities will not help prevent further episodes of growing pains and may actually make pain worse.
Typically, with a thorough medical history and physical exam, a doctor can make the diagnosis of growing pains without performing imaging studies or laboratory tests. If such tests are performed, however, they will return normal results. In children who have more concerning symptoms such as fever, weight loss, worsening pain during the daytime, limp or the inability to participate in typical activities, further evaluation is necessary to look for other possible conditions. Further testing is also important for those who display other concerning signs during the physical examination, such as joint swelling or limited range of motion.
Parents should be on the lookout for the following symptoms:
Pain accompanied by fever, a rash or loss of appetite should prompt an immediate visit to the child’s doctor. A more serious problem can be misdiagnosed as growing pains, and if a child is experiencing persistent pain, it may be a good idea to see an expert.
If growing pains persist and/or consistently wake a child from sound sleep, it is important to consult a specialist to rule out something more worrisome that may need to be treated with prescription medication or even surgical intervention. Bone or joint infections, leukemia, osteoid osteoma (type of benign bone tumor), or malignant bone or soft tissue tumors are exceptionally rare but may cause consistent nighttime wakening. These conditions may or may not be accompanied by fever, chills, joint or extremity swelling, limited range of motion, skin changes, and weight loss. Juvenile idiopathic arthritis may cause pain in the same location and have similar presenting symptoms, but more often cause pain and stiffness in the morning, rather than in the middle of the night during sleep.
Growing pains may occur episodically and last from minutes to hours. They may resolve after a few days or after many months. They may never present again or may recur until late childhood/ early adolescence.
Though there is no clinical evidence, growing pains may be due to overuse in particular limbs or extremities. In one small study, investigators found that bone strength density in children with growing pains was less than that in healthy children.2 Therefore, vitamin D3 (RDA recommends 600 international units daily) may help, as it increases absorption of calcium to strengthen growing bones.
Learn more about conditions that may be mistaken for growing pains.
Get a deep dive on conditions and injuries that cause pain in children.