“I…hurt…my…KNEE!” your child screams in between sobs.
“What happened?” you calmly ask.
“I fell down and scraped it!”
“Well, let’s clean it up, put a Band-aid on, and get you back outside.”
This scenario is so commonplace in a household with children that most parents don’t even realize they have just effectively conducted a medical office visit for a pediatric patient complaining of musculoskeletal pain -- or pain that affects the muscles, joints and tendons along with bones.
Fortunately, as in this case, the cause of pediatric leg or arm pain is often fairly clear and doesn’t require extensive investigation. However, the cause of musculoskeletal pain isn’t always so obvious, and can lead to significant discomfort and anxiety for children and their parents.
“Growing pains” are one of the more troublesome causes of childhood musculoskeletal pain. This condition is surprisingly common, affecting as many as one-third of children between the ages of 3 and 12. Frequently, there is a family history of the problem. Interestingly, the term “growing pains” is a bit of a misnomer since the pain doesn’t necessarily occur during growth spurts or even in areas of the body where the most active growth is occurring. Consequently, many physicians have taken to calling it “benign limb pain of childhood.”
Typically, children with this condition experience intense pain in both shins, often lasting up to an hour or longer, during the evening. These events can awaken them (and the rest of the family) from sleep and cause significant amounts of distress for everyone involved. Physically everything appears normal and there are no other signs of illness. Comforting measures, such as rubbing the painful parts, usually provides eventual relief but medications like ibuprofen or acetaminophen can also be helpful.
Children who are otherwise healthy, have normal growth and experience occasional growing pains don’t usually require additional medical exams. However, red flags that should raise suspicion and might warrant further evaluation include: pain which occurs on only one side or limb, symptoms that persist during the day, associated bone or joint swelling, or symptoms of illness such as fever, weight loss or excessive fatigue.
Although our understanding of why benign limb pain of childhood develops is limited, we know that most children grow out of it and don’t suffer any long-term complications. Unfortunately, some children and families do continue to deal with recurrent attacks for years. There’s some solace in knowing that even in these longer cases, episodes generally become less frequent over time and no physical damage is being done.
Dr. Bradley Ornstein is a pediatric rheumatologist and infectious disease physician with Mercy Children’s Hospital St. Louis and Mercy Clinic.