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The Pain of Growing Pains

Growing pains aren't always caused by growth. Dr. Derek Kelly, pediatric orthopedic surgeon, discusses this complaint and what to do if your child is troubled by growing pains.
The Pain of Growing Pains
Featuring:
Derek Kelly, MD
Dr. Kelly is certified by the American Board of Orthopedic Surgery. He is an associate professor at University of Tennessee – Campbell Clinic Department of Orthopedics. Dr. Kelly has chaired and served on committees of the Pediatric Orthopedic Society of North America. His research has been published in Journal of Children’s Orthopedics, The Journal of Pediatric Orthopedics and Journal of Bone and Joint Surgery, just to name a few. He specializes in the diagnosis and treatment of newborn foot deformities, pediatric and adolescent spinal deformity (scoliosis), and newborn, pediatric, and adolescent hip disease.
Transcription:

Bill Klaproth (Host): Growing pains are commonly found in children from ages three to twelve, but they aren’t actually caused by growth. So, Dr. Derek Kelly, Pediatric Orthopedic surgeon will discuss common misconceptions, what to look for if your child is complaining of pain and the types of treatment. This is the Peds Pod by Le Bonheur Children’s Hospital. I’m Bill Klaproth. Dr. Kelly, thank you so much for your time. So, first off, what are growing pains?

Derek Kelly, MD (Guest): Well that’s probably one of the more difficult questions that we’re going to be able to answer because we really, in the medical field, don’t exactly know what growing pains are. They do tend to occur in children; therefore, they occur at a point in life when you are growing but they probably don’t have a whole lot to do with actual growing.

Host: Interesting. So, what causes growing pains? Do we know that?

Dr. Kelly: We think they are related to the tissues around the bones where the muscles and tendons and ligaments attach to the bones. And so they are probably are caused by lots of activity. We tend to know that kids like to run and play and jump and perhaps the stress of running and playing and jumping creates some pain in those areas.

Host: Okay so, what should we look out for then or expect when our child is having growing pains?

Dr. Kelly: Growing pains typically show up in the evenings around bedtime and then soon after bed in the early hours after a kid goes to sleep. They are usually in both legs, probably more legs than arms. And usually from around the knee down towards the ankle in the region of the shin bone that kids will have some mild aching pain, sometimes up to some really sharp and intense pains. Often making it difficult for them to go to sleep or after they go to sleep, they will often wake up in pain.

Host: You know I can remember having these as a kid and what you described, right the lower leg and hurt just like an ache. So like owe what is this? And not fun as a kid that’s for sure. And how long do they usually last?

Dr. Kelly: They can last for a few hours. Usually they don’t get to last that long though because they are intense enough as you say that the kids will wake up the parents and try to get some help and then the parents do various things such as massages or give them some medicines and within a short time, the pain resolves and usually the children are able to go back to sleep. And then they are typically gone by the morning and they may come back the next night or it may be days or weeks before they come back.

Host: Okay you just mentioned a parent might massage the child’s leg or medicine. What type of medicine are you talking about and are there other things a parent can do to help their child with growing pains?

Dr. Kelly: Yes, so as long as it’s okay for your child to take over-the-counter medicines like Tylenol or ibuprofen; those medicines are usually fairly effective. I don’t often recommend them that my patients or families take those medicine every night but for those nights that they are really having symptoms, it’s nice to have those medicines around. If you child has any issues with those medicines of course you should avoid those.

But often the child will wake up let’s say 10, 11, 12 o’clock at night after going to bed and then a dose of pain medication within 15 or 20 minutes, the medicine will start to work, and they’ll feel better. But outside of medications, simple things like heating pads, as long as they are supervised or just massaging the legs for a few minutes will allow the symptoms to resolve.

Host: And when should a parent reach out to their pediatrician about growing pains?

Dr. Kelly: Well anytime the family is concerned you should seek care. The more challenging or concerning symptoms are maybe if it only occurs in one leg, if it’s every single night, if it’s at odd times of the day outside of growing pain hours. So, if the child is having pain in the mornings or throughout the day at school, if there’s any redness or swelling, any types of deformities. If the leg or arm look different then of course they should seek care sooner. If it’s that achy pain that occurs in both legs between the knees and the ankles, between like eight o’clock and midnight; those are probably fairly routine growing pains. But anytime the family is concerned, they should probably have it checked.

Host: And is there anything that we should watch out for that maybe we would then consider consulting an orthopedic specialist?

Dr. Kelly: Well so, if you start with the pediatrician and the pediatrician is concerned it could be something else then they may often refer to an orthopedic surgeon. Again some of the same things. if it’s a single leg, if there’s any deformity, redness or swelling, the child is having any fevers associated with it. But a pediatric workup can be a specialist or a pediatrician, both would be good options if the family is concerned.

Host: So, you mentioned the physical activity earlier. Kids running around. Does that spur growing pains at night? Is there a direct correlation?

Dr. Kelly: It’s not direct, but it seems to be. There are a few studies that have come out on growing pains in the last decade or so that seem to show that symptoms are worse on the days when the children are much more active. If say it’s a rainy day and the child spends more time inside playing video games or coloring or doing puzzles compared to days where they are out running and playing and jumping. Those more active days tend to cause more symptoms. But it’s not always that way. Kids can even have growing pains on days when they are fairly relaxed as well.

Host: So, you mentioned at night generally this happens. Why is that? Is that generally when kids will experience this at night?

Dr. Kelly: It’s complicated and I’m not sure we know the answer. Perhaps at night the children have slowed down, their minds are relaxing, they are not thinking about all the other things that they are doing during the day and they may be can pay more attention to their pain. There are a couple of theories along that line. One of the reasons we thought that growing pains were related to growth was that growth hormone levels tend to rise a little bit in the night and so perhaps people thought that the growing pains had something to do actually with growth. But that’s probably not true. So, it’s multifactorial. And in the end, I don’t know that we really know why the night is the worst time.

Host: Just curious, do vitamins help? If a parent is thinking maybe if I give my child vitamins, that will help. Any research on that?

Dr. Kelly: There is no really good research on that as to whether or not vitamins or dietary changes affect growing pains one way or the other. Now for good bone health, a good healthy diet, vitamin D and calcium and making sure those levels are appropriate if there is any concern would always be a good idea for children. But in the end, I don’t know that we have any dietary supplements or vitamins that would do anything for growing pains.

Host: Right. So, it sounds like just make sure you pay attention and have a well-balanced diet. And we’ve been talking primarily about the legs, lower extremities having these growing pains. Is that generally the muscles or joints where growing pains happen? Any others?

Dr. Kelly: Yes certainly. I’ve made the diagnosis of growing pains in the upper extremities say around the shoulders or the elbows, very similar symptoms. The pains usually occur at night and they occur on multiple days. I’ve also made the diagnosis of growing pains as it relates to the back pain. But we in the medical community, we call growing pains a diagnosis, a diagnosis of exclusion. If the history and the physical exam and sometimes testing have ruled out other causes, more serious causes like trauma or infection; then we can go on to make the diagnosis of growing pains. But it can be in other joints. It can be in the upper extremities, back as well as the legs. Just the legs are quite a bit more common.

Host: Got you. Dr. Kelly thank you for your time. One last question, as I said, I remember having these as a kid. Do all kids get these or no?

Dr. Kelly: No, the epidemiology on the studies of all the studies that have been done suggest anywhere from 10% up to maybe even a third of kids will have some experience of growing pains. The really severe growing pains, the ones that are so, so bad that the family seek care is probably anywhere from five to ten percent. Maybe even less.

Host: Got you. God, just thinking about it, my lower leg is starting to hurt a little bit. I don’t know why that is.

Dr. Kelly: It is certainly miserable, and it is certainly very distressing for the families to have a child who is in severe pain and very difficult to console. So, yes, it’s really quite a challenge for many families.

Host: Yeah, that’s for sure. Well Dr. Kelly, thanks so much for your time today. We’ve enjoyed talking with you. Thanks again.

Dr. Kelly: Thank you.

Host: That’s Dr. Derek Kelly, Pediatric Orthopedic Surgeon at Le Bonheur Children’s Hospital. To learn more all you have to do is visit www.lebonheur.org/podcast and be sure to subscribe to the Peds Pod in Apple Podcasts, Google Play or wherever you listen to your podcasts. You can also check out www.lebonheur.org/podcast to view our full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children’s Hospital. Thanks for listening.