Growing Pains in Children: Symptoms, Causes & Home Treatment
Quick Facts About Growing Pains
Key Takeaways
- Growing pains are common and affect up to one-third of children, primarily between ages 3-12
- Pain occurs at night, typically in the thighs, calves, and behind the knees, and is absent during the day
- Not related to actual growth — despite the name, there is no scientific evidence linking the pain to bone growth
- Home treatment is effective — massage, warmth, and comfort measures usually resolve symptoms within minutes
- No long-term effects — growing pains are benign and resolve completely by adolescence
- See a doctor if pain persists during the day, affects only one leg, or is accompanied by swelling, limping, or fever
- Physical examination is normal — children with true growing pains show no signs of joint or muscle abnormalities
What Are Growing Pains in Children?
Growing pains are recurring episodes of leg pain that affect children, typically occurring in the evening or at night and completely resolving by morning. The pain is most commonly felt in the thighs, calves, and behind the knees, and affects both legs equally over time. Despite causing significant discomfort, growing pains are a benign condition with no lasting effects on the child's health or development.
Growing pains represent one of the most common causes of recurring musculoskeletal pain in childhood, affecting an estimated 10 to 35 percent of children at some point during their development. The condition has been recognized in medical literature for over 200 years, with the term "growing pains" first coined by French physician Marcel Duchamp in 1823. However, this terminology has persisted despite our current understanding that the pain is not actually caused by the process of bone growth itself.
The hallmark characteristic of growing pains is their nocturnal timing. Children with this condition wake at night complaining of leg pain, often crying or calling for their parents. The pain can be quite intense and distressing, both for the child experiencing it and for parents witnessing their child's discomfort. However, a distinguishing feature of true growing pains is that the child is completely symptom-free during the daytime and can participate in normal activities without any limitations.
The condition typically follows a pattern of intermittent episodes. Some children experience pain several times per week, while others may have episodes only once a month or even less frequently. The episodic nature of the condition, combined with the absence of any physical findings on examination, helps differentiate growing pains from other more serious causes of pediatric leg pain.
Medical Terminology and Classification
In medical literature, growing pains are also referred to as "benign nocturnal limb pains of childhood" or "recurrent limb pain in childhood." These alternative names more accurately describe the condition, as they do not imply a causative relationship with growth. The condition is classified under ICD-10 code M79.609 (pain in unspecified limb) since there is no specific diagnostic code for growing pains themselves.
Growing pains are considered a diagnosis of exclusion, meaning that other potential causes of leg pain must be ruled out before the diagnosis can be made. When the characteristic pattern of symptoms is present and physical examination is normal, no further diagnostic testing is typically required.
What Are the Symptoms of Growing Pains?
The classic symptoms of growing pains include deep, aching pain in the legs that occurs in the evening or wakes the child at night. The pain typically affects both legs (though not necessarily at the same time), is located in the muscles of the thighs, calves, or behind the knees, and completely disappears by morning with no symptoms during the day.
Understanding the specific characteristics of growing pains symptoms is crucial for parents to distinguish this benign condition from other causes of childhood leg pain that may require medical attention. The symptom pattern of growing pains is remarkably consistent across affected children, which aids in recognition and appropriate management.
The pain associated with growing pains is typically described as a deep, aching sensation that children may have difficulty localizing precisely. Unlike pain from injury or inflammation, which is usually sharp and well-defined, growing pains create a more diffuse discomfort that seems to come from deep within the muscles. Children may describe the feeling as their legs "hurting all over" or point to vague areas of the thighs and calves when asked to show where it hurts.
One of the most distinctive features of growing pains is the timing of symptoms. The pain characteristically occurs in the late afternoon, evening, or at night, often waking the child from sleep. Many parents report that their child goes to bed without any complaints but wakes crying several hours later with leg pain. This nocturnal pattern is so characteristic that daytime pain should prompt consideration of alternative diagnoses.
Location of Pain
Growing pains most commonly affect the following areas:
- Front of the thighs: The quadriceps muscle group is frequently involved
- Calves: The gastrocnemius and soleus muscles of the lower leg
- Behind the knees: The popliteal fossa region
- Shins: Less commonly, the anterior lower leg may be affected
Importantly, growing pains do not affect the joints. If a child complains of pain specifically in the knee joint, ankle, or hip, this suggests a different diagnosis and warrants medical evaluation. The muscular nature of growing pains distinguishes them from conditions affecting joints or bones.
Duration and Frequency
Individual episodes of growing pains typically last between 10 and 30 minutes, though some children may experience pain for up to several hours. The pain usually responds well to comfort measures such as massage and warmth, gradually subsiding and allowing the child to return to sleep. By morning, the child is completely symptom-free and can engage in normal activities without any residual discomfort.
The frequency of episodes varies considerably among affected children. Some experience pain almost every night for a period, while others may have episodes only once weekly or even less frequently. Many parents notice that episodes tend to occur after particularly active days, suggesting a relationship between physical activity and symptom onset.
Bilateral Involvement
Growing pains typically affect both legs over time, though not necessarily simultaneously during a single episode. A child may complain of right leg pain one night and left leg pain the next. This bilateral, alternating pattern is characteristic of the condition. Pain that consistently affects only one leg or always occurs in the same location should raise concern for other diagnoses.
What Causes Growing Pains?
The exact cause of growing pains remains unknown despite extensive research. Contrary to what the name suggests, there is no scientific evidence that growing pains are caused by bone growth. Current theories suggest that muscle fatigue from physical activity, lower pain threshold in affected children, anatomical factors such as flat feet, and genetic predisposition may all play a role in the development of this condition.
The pathophysiology of growing pains has been the subject of considerable scientific inquiry, yet no single cause has been definitively identified. This uncertainty is reflected in the ongoing debate about whether "growing pains" is even an appropriate term for the condition. Multiple studies have examined the relationship between growth and pain episodes, consistently failing to find a correlation between growth spurts and symptom occurrence.
Research has demonstrated that children experience growing pains during all stages of development, not specifically during periods of rapid growth. Furthermore, the pain occurs in the muscles rather than in the bones or growth plates, which are the structures involved in actual skeletal growth. These observations have led researchers to explore alternative explanations for this common childhood condition.
Muscle Fatigue Theory
One of the most widely accepted theories proposes that growing pains result from muscle fatigue following periods of increased physical activity. Studies have shown that children are more likely to experience growing pains episodes on days when they have been particularly active, such as after sports practices, playground activities, or extended periods of running and jumping.
This theory is supported by the observation that growing pains occur most commonly in the late afternoon or evening, after the cumulative physical stress of the day has taken its toll on the muscles. The muscular location of the pain and its improvement with massage and warmth also align with this hypothesis. However, the muscle fatigue theory does not fully explain why some children experience growing pains while others with similar activity levels do not.
Lower Pain Threshold
Research suggests that children who experience growing pains may have a lower pain threshold compared to their unaffected peers. This means that sensations that would not be perceived as painful by most children may register as significant discomfort in children prone to growing pains. Studies measuring pain sensitivity have found differences between children with and without growing pains, supporting this hypothesis.
Additionally, some researchers have proposed that emotional factors such as stress or anxiety may contribute to pain perception in affected children. The family environment and how pain is addressed and managed may also influence how children experience and report symptoms.
Anatomical Factors
Certain anatomical variations have been associated with an increased likelihood of growing pains. These include:
- Flat feet (pes planus): Children with flat feet may experience altered biomechanics that place additional stress on leg muscles
- Hypermobility: Joint hypermobility may contribute to muscle strain during activity
- Lower limb alignment: Variations in leg alignment such as genu valgum (knock-knees) or genu varum (bow legs) may play a role
Genetic Factors
Growing pains tend to run in families, suggesting a genetic component to the condition. Many parents of children with growing pains report experiencing similar symptoms during their own childhood. While specific genes responsible for this predisposition have not been identified, the familial clustering supports the idea that genetic factors influence susceptibility to the condition.
How Are Growing Pains Diagnosed?
Growing pains are diagnosed based on the characteristic clinical pattern of symptoms and a normal physical examination. There is no specific laboratory test or imaging study that confirms growing pains. The diagnosis is made when typical symptoms are present and other potential causes of leg pain have been excluded through clinical evaluation.
The diagnosis of growing pains is primarily clinical, relying on a careful history and thorough physical examination. Healthcare providers look for the classic pattern of symptoms: bilateral leg pain occurring at night or in the evening, affecting the muscles rather than joints, completely resolving by morning, and not associated with any physical abnormalities on examination.
During the medical history, the provider will ask detailed questions about the characteristics of the pain, including its location, timing, duration, and relationship to activities. They will also inquire about any associated symptoms such as fever, weight loss, limping, or morning stiffness, which would suggest alternative diagnoses.
Physical Examination
A comprehensive physical examination is essential in evaluating a child with leg pain. The examination includes assessment of:
- Range of motion of all joints in the lower extremities
- Muscle strength and tone
- Presence of swelling, warmth, or redness
- Gait pattern and ability to walk normally
- Tenderness on palpation of bones, joints, and muscles
- General health assessment including lymph node examination
In children with true growing pains, the physical examination is entirely normal. The child can walk, run, and jump without difficulty, and there are no signs of inflammation, tenderness, or structural abnormality. This normal examination is crucial for distinguishing growing pains from more serious conditions.
Diagnostic Criteria
While there are no universally accepted diagnostic criteria for growing pains, most clinicians use the following features to establish the diagnosis:
| Criteria | Typical Finding |
|---|---|
| Pain location | Bilateral, in muscles (not joints) |
| Timing | Evening or night; absent during day |
| Physical examination | Completely normal |
| Duration | Intermittent episodes over months to years |
| Response to comfort measures | Improves with massage, warmth |
When Additional Testing May Be Needed
In most cases, when the history and physical examination are consistent with growing pains, no additional testing is required. However, laboratory tests or imaging studies may be ordered if there are features that raise concern for other conditions, such as:
- Pain that persists during the daytime
- Pain consistently localized to one specific area
- Swelling, redness, or warmth over the affected area
- Limping or difficulty walking
- Fever or other systemic symptoms
- Pain that wakes the child from sleep and is not relieved by comfort measures
How Can You Treat Growing Pains at Home?
Growing pains can be effectively managed at home with simple comfort measures including gentle massage of the affected area, application of warmth through heating pads or warm compresses, stretching exercises, and providing reassurance to the child. Over-the-counter pain medications such as paracetamol (acetaminophen) or ibuprofen can be used for more persistent episodes.
The management of growing pains focuses on providing symptomatic relief during episodes and reassuring both the child and parents about the benign nature of the condition. Since growing pains resolve on their own and do not cause any long-term harm, the goal of treatment is to minimize discomfort and help the child return to sleep as quickly as possible.
Parents play a crucial role in managing growing pains, as their calm and reassuring response can significantly influence how the child experiences and copes with the pain. Children who feel supported and understood tend to have less anxiety about their symptoms, which may help reduce pain perception.
Massage Therapy
Gentle massage of the affected muscles is one of the most effective treatments for growing pains. When a child wakes with leg pain, sitting with them and gently massaging the painful areas provides both physical relief through improved blood circulation and emotional comfort through parental presence. Use firm but gentle pressure, kneading the muscles of the thighs and calves for 5 to 10 minutes or until the pain subsides.
The therapeutic benefits of massage for growing pains likely include increased blood flow to the muscles, relaxation of muscle tension, and the release of endorphins that help reduce pain perception. Additionally, the nurturing aspect of a parent providing massage can help calm the child and reduce anxiety associated with nighttime waking.
Heat Application
Warmth is another effective treatment that provides soothing relief for growing pains. Heat can be applied in several ways:
- Heating pad: Apply a warm (not hot) heating pad to the affected area for 15-20 minutes
- Warm compress: A washcloth soaked in warm water can be applied to the legs
- Warm bath: A brief warm bath before bed may help prevent episodes
- Warm socks or leg warmers: Having the child sleep in warm socks can provide ongoing comfort
- Warm blanket: A cozy blanket wrapped around the legs can help
Always ensure that heating pads are set to a comfortable temperature to prevent burns, and never leave a heating pad on an unsupervised or sleeping child.
Stretching Exercises
Regular stretching of the leg muscles may help reduce the frequency and severity of growing pains episodes. Gentle stretching exercises performed before bedtime can help relax the muscles and may prevent nighttime symptoms. Helpful stretches include:
- Hamstring stretch: Have the child sit with legs extended and reach toward their toes
- Quadriceps stretch: While standing and holding onto something for balance, bend one knee and bring the heel toward the buttocks
- Calf stretch: Place hands against a wall, step one foot back, and lean forward while keeping the back heel on the ground
These stretches should be gentle and held for 15-30 seconds each. Making stretching a regular part of the bedtime routine can help establish healthy habits while potentially reducing growing pains episodes.
What Medications Help Growing Pains?
When massage and warmth are not sufficient to relieve growing pains, over-the-counter pain medications such as paracetamol (acetaminophen) or ibuprofen can be used. These medications should be given according to the child's age and weight following package instructions. Aspirin should be avoided in children due to the risk of Reye's syndrome.
While non-pharmacological measures are usually sufficient for managing growing pains, there are times when medication may be helpful, particularly for more severe or persistent episodes. It's important for parents to understand when and how to use pain medications safely in children.
Over-the-counter pain relievers can be effective when the pain is too intense for comfort measures alone or when the child is having difficulty returning to sleep despite massage and warmth. However, these medications should not be used on a nightly basis and are best reserved for occasional more difficult episodes.
Paracetamol (Acetaminophen)
Paracetamol is generally considered the first-line medication for growing pains in children. It provides effective pain relief and has a good safety profile when used according to dosing guidelines. Key points about using paracetamol:
- Always dose according to the child's weight, not just age
- Follow the manufacturer's instructions on the package
- Do not exceed the maximum daily dose
- Allow adequate time between doses (typically 4-6 hours)
- Keep track of all sources of paracetamol to avoid accidental overdose from combination products
Ibuprofen
Ibuprofen is an anti-inflammatory medication that can also be effective for growing pains. It may be particularly helpful when muscle inflammation from overuse is contributing to symptoms. Considerations for ibuprofen use:
- Give with food to reduce stomach upset
- Not recommended for children under 6 months of age
- Follow weight-based dosing instructions
- Avoid in children with kidney problems, stomach ulcers, or bleeding disorders
Always read medication labels carefully and use the measuring device provided with the product. Kitchen spoons vary in size and are not accurate for measuring medication doses. If you have questions about proper dosing for your child, consult your pharmacist or healthcare provider.
When Should You See a Doctor for Growing Pains?
While growing pains are benign and do not require medical treatment, you should see a doctor if your child's leg pain persists during the daytime, always affects the same location, is accompanied by swelling, redness, or warmth, causes limping or difficulty walking, or is associated with fever, weight loss, or fatigue. These symptoms may indicate a different condition requiring evaluation.
Most children with growing pains do not need to see a doctor once the diagnosis has been established and parents are familiar with managing symptoms at home. However, there are certain warning signs that should prompt medical evaluation to rule out other causes of leg pain that may require specific treatment.
Parents should trust their instincts — if something seems different about their child's pain or if they are concerned that the symptoms don't fit the typical pattern of growing pains, seeking medical advice is appropriate. It's always better to have concerning symptoms evaluated than to miss a condition that requires treatment.
Red Flag Symptoms
- Pain that persists during the daytime or is present upon waking
- Pain that consistently affects only one leg or always the same location
- Visible swelling, redness, or warmth over the painful area
- Limping or difficulty bearing weight on the affected leg
- Fever, especially if associated with leg pain
- Unexplained weight loss or decreased appetite
- Fatigue or appearing unwell
- Pain that is severe enough to limit daily activities
- Joint pain rather than muscle pain
- Pain that does not respond to usual comfort measures
Conditions That May Mimic Growing Pains
Several other conditions can cause leg pain in children and may initially be confused with growing pains. These include:
- Juvenile idiopathic arthritis: Inflammatory condition affecting joints, causing swelling and morning stiffness
- Legg-Calvé-Perthes disease: A hip condition causing limping and thigh or knee pain
- Osteomyelitis: Bone infection causing localized pain, swelling, and fever
- Bone tumors: Rare but important to consider with persistent, localized pain
- Restless leg syndrome: Uncomfortable sensations in legs with urge to move
- Stress fractures: Overuse injuries causing localized bone pain
- Sever's disease: Heel pain in active children related to growth plate inflammation
A healthcare provider can differentiate between these conditions and growing pains through careful history taking and physical examination. In some cases, additional tests such as blood work or imaging may be needed to reach a definitive diagnosis.
Can You Prevent Growing Pains?
While growing pains cannot be entirely prevented, certain strategies may help reduce their frequency and severity. These include regular stretching exercises before bedtime, maintaining good hydration throughout the day, ensuring adequate rest, and gradually increasing physical activity levels rather than engaging in sudden intense exercise.
Since the exact cause of growing pains remains unknown, there is no guaranteed way to prevent them completely. However, based on our understanding of potential contributing factors, several lifestyle modifications may help reduce the frequency and intensity of episodes.
Parents often notice patterns in when their child experiences growing pains, which can help guide preventive strategies. For example, if episodes tend to occur after particularly active days, measures to reduce muscle fatigue may be helpful.
Preventive Strategies
- Regular stretching: Incorporate gentle stretching exercises into the daily routine, particularly before bedtime
- Stay hydrated: Ensure the child drinks adequate water throughout the day, as dehydration may contribute to muscle cramping
- Gradual activity increases: Avoid sudden increases in physical activity intensity
- Adequate rest: Ensure the child gets sufficient sleep and rest periods
- Supportive footwear: Well-fitting shoes with good arch support may help, especially for children with flat feet
- Warm bath before bed: A relaxing warm bath can help relax muscles before sleep
- Address underlying conditions: If flat feet or hypermobility are present, consider consultation with a specialist
Activity Considerations
Children with growing pains should not avoid physical activity, as exercise is important for healthy development. However, being mindful of activity levels and building in appropriate rest periods can help. After particularly active days, proactive measures such as stretching and massage before bed may help prevent nighttime symptoms.
What Is the Outlook for Growing Pains?
The prognosis for growing pains is excellent. The condition is entirely benign and does not cause any long-term damage to muscles, bones, or joints. Most children outgrow the condition by adolescence, typically between ages 10-12, though some may continue to experience occasional episodes into their teenage years.
Parents can be reassured that growing pains, while uncomfortable for the child, do not indicate any serious underlying health problem and will not affect their child's growth, development, or future musculoskeletal health. The condition runs its natural course and eventually resolves completely.
The duration of the condition varies among children. Some may experience growing pains for only a few months, while others may have intermittent episodes for several years. Throughout this time, the symptoms remain manageable with home treatment, and the child can continue to participate fully in all normal activities.
Long-Term Outcomes
Research following children with growing pains into adulthood has found no increased risk of musculoskeletal problems, chronic pain conditions, or other health issues related to having had growing pains in childhood. The condition leaves no lasting effects once it resolves.
Some studies have suggested that children who experience growing pains may have a somewhat lower pain threshold and may be more likely to experience certain functional pain conditions, but this remains an area of ongoing research and does not indicate any serious health concern.
Frequently Asked Questions About Growing Pains
Growing pains most commonly begin between 3 and 5 years of age, with a second peak in occurrence between 8 and 12 years. The condition is rare in children under 3 years old and becomes less common after puberty. While any child within the 3-12 age range can experience growing pains, the condition appears to be most prevalent during the early school years. If a child younger than 3 or older than 12 experiences symptoms similar to growing pains, it's advisable to consult a healthcare provider to rule out other conditions.
No, growing pains are not directly related to growth spurts. Despite the name, scientific research has found no correlation between periods of rapid growth and the occurrence of growing pains episodes. The term "growing pains" is somewhat of a misnomer that has persisted historically. Children experience these pains throughout their development, not specifically during times of increased growth. The pain occurs in the muscles, not in the bones or growth plates where actual growth takes place.
The nocturnal timing of growing pains is one of the hallmark characteristics of the condition. While the exact reason is not fully understood, several theories may explain this pattern. The leading theory suggests that muscles fatigued from daily activities become symptomatic when the child is at rest. During the day, movement and activity may mask any discomfort. Additionally, the relaxation of sleep may heighten awareness of muscle sensations, and some research suggests that lower pain thresholds at night may play a role. If your child experiences leg pain during the day, this may indicate a different condition.
Research suggests that growing pains may have a genetic component. Many parents of children with growing pains report experiencing similar symptoms during their own childhood. Studies have found that children with growing pains are more likely to have family members who also experienced the condition. While no specific genes have been identified as responsible, the familial pattern suggests that genetic factors may influence susceptibility. If you had growing pains as a child, your children may be more likely to experience them as well.
No, children with growing pains should not restrict their physical activities. Exercise is important for healthy development and should continue normally. Growing pains do not indicate injury or damage that could be worsened by activity. The child is completely symptom-free during the day and can participate in sports, playground activities, and other physical pursuits without limitation. However, after particularly active days, you might want to proactively use stretching and massage before bed to help prevent nighttime symptoms. Gradual increases in activity intensity, rather than sudden intense exercise, may also help reduce episodes.
Growing pains predominantly affect the legs and are most commonly felt in the thighs, calves, and behind the knees. While arm pain is not a typical feature of growing pains, some children may occasionally report upper extremity symptoms. However, if arm pain is the primary complaint or occurs frequently, this should be evaluated by a healthcare provider as it may indicate a different condition. True growing pains have a characteristic pattern of lower extremity involvement, nocturnal occurrence, and absence of physical findings, which helps distinguish them from other causes of musculoskeletal pain in children.
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Medical Editorial Team
This article was created by the iMedic medical editorial team and reviewed according to our strict editorial standards.
Evidence Standard: All medical claims in this article are supported by peer-reviewed research and follow the GRADE evidence framework. Content adheres to guidelines from the American Academy of Pediatrics (AAP), European League Against Rheumatism (EULAR), and World Health Organization (WHO).