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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 Rheumatology at http://www.rheumatology.org/index.asp and the American Academy of Orthopedic Surgeons at https://www.aaos.org/. Dr. Lehman provides more information about the childhood rheumatic diseases at www.goldscout.com

 

About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.

 

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