Review Question - QID 105414

Bilateral lower-extremity pain that occurs at night in children from age 2-12 is indicative of growing pain. In the absence of other systemic symptoms, these are normal, and only reassurance is needed.

Growing pains are a common occurrence in young children. They are present in 25-40% of children 3-5 and 8-12 years of age. Often they are described as muscular rather than joint pains in the anterior thighs, calves, and behind the knees. Pain often occurs late in the day or at night. Importantly, these children deny swollen, red, warm, or tender joints. If a child appears ill or complains of pain during the day and with activity or if the pain begins to worsen or persist over months, the diagnosis is unlikely to be growing pains. In that case, a thorough evaluation--including CBC and differential, ESR, CRP, and radiographs--is needed.

Manners discusses growing pains and other common musculoskeletal problems in children. The typical case of growing pains occurs in a healthy, clinically normal, young child, in the middle of the night, causing intense pain for 10 to 15 minutes in both legs (knees, thighs, calves or shins). Management hinges on simple analgesic measures for the child and reassurance for the parents that a serious condition is not present.

Pavone et al. discuss thirty case reports of growing pains. After grouping the patients and conducting a statistical analysis, they found that patients had pain during the night and afternoon in 43.3% and 56.7% of cases, respectively. Both lower limbs were involved in 80% of cases, causing awakening and crying episodes in 40% and 37% of cases, respectively. The frequency of pain was as follows: daily, 5%; weekly, 45%; monthly, 35%; and every 3 months, 15%. The pains were relieved by massaging the affected site in 95% of cases.

Incorrect Answers:
Answer 1: Lower extremity venous ultrasound would be useful to rule out a deep venous thrombosis, though this diagnosis is less likely in a young patient without risk factors, and bilateral DVTs would be even more rare.
Answer 2: MRI of the knees would not be indicated and is better suited to diagnose ligamentous injuries of the knee.
Answer 3: A radiograph of the knee would be indicated if the patient were showing signs of joint pathology such a septic knee, but these symptoms are more indicative of growing pains.
Answer 4: ESR and CRP may be elevated in a septic joint.