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TYPE
Original Research
PAGE NO.
16-24
10.37547/tajmspr/Volume07Issue06-03
OPEN ACCESS
SUBMITED
19 April 2025
ACCEPTED
23 May 2025
PUBLISHED
24 June 2025
VOLUME
Vol.07 Issue 06 2025
CITATION
Muhammad Nouman Tariq, Maisha Tasfia Chowdhury, Syed Shayan Gilani,
Shumaila Abu Bakar Bhura, Rasheed Ibikunle, Bazaid Muhammad, Faryal
Sikandar, Nayab Shakoor, Rizwan Uppal, Muhammad Rehan Uppal, Umar
Saeed, Zahra Zahid Piracha, Muhammad Ahmad, & Muhammad Zeeshan
Tariq. (2025). Navigating Growing Pains in Pediatric Emergency Care: New
Perspectives and Emerging Challenges. The American Journal of Medical
Sciences
and
Pharmaceutical
Research,
7(06),
16
–
24.
https://doi.org/10.37547/tajmspr/Volume07Issue06-03.
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Navigating Growing Pains
in Pediatric Emergency
Care: New Perspectives
and Emerging Challenges
Muhammad Nouman Tariq
International Center of Medical Sciences Research (ICMSR),
Islamabad PAKISTAN
Akhtar Saeed Medical and Dental College
Maisha Tasfia Chowdhury
Bangladesh Medical College Hospital
Syed Shayan Gilani
Akhtar Saeed Medical and Dental College
Sheikh Zayed Hospital, Lahore
Shumaila Abu Bakar Bhura
Dow International Medical College, DUHS, Karachi
Rasheed Ibikunle
College of Medicine, University of Lagos, Nigeria
Bazaid Muhammad
Akhtar Saeed Medical and Dental College
Faryal Sikandar
University of Lahore
Nayab Shakoor
University of Nottingham
Rizwan Uppal
Islamabad Diagnostic Center (IDC), F8 Markaz, Islamabad
PAKISTAN
Muhammad Rehan Uppal
Islamabad Diagnostic Center (IDC), F8 Markaz, Islamabad
PAKISTAN
Umar Saeed
Foundation University Islamabad (FUI), Islamabad PAKISTAN
The American Journal of Medical Sciences and Pharmaceutical Research
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The American Journal of Medical Sciences and Pharmaceutical Research
Zahra Zahid Piracha
International Center of Medical Sciences Research (ICMSR),
Islamabad PAKISTAN
International Center of Medical Sciences Research (ICMSR),
Austin, TX, United States of America
International Center of Medical Sciences Research (ICMSR),
Chadwell Heath, United Kingdom.
Corresponding Authors: Dr Zahra Zahid Piracha and
Dr Umar Saeed
Acknowledgments:
We would like to express our sincere gratitude to
the following individuals for their invaluable support
and contributions to this research:
Muhammad Ahmad
Affiliation: Nishtar Medical College, Multan
Muhammad Zeeshan Tariq
Affiliation: University of Huddersfield
Abstract:
Growing pains are a prevalent condition in
children, often leading to discomfort and anxiety for
both patients and their families. These pains typically
manifest as bilateral limb discomfort that occurs
primarily in the evenings or at night, affecting
approximately 10-20% of the pediatric population.
Despite their benign nature, growing pains pose
significant challenges in pediatric emergency care due to
their episodic nature and lack of specific diagnostic
markers.
Recent research has shifted the understanding of
growing pains from a simplistic view of mere skeletal
growth to a multifactorial condition influenced by
genetic
predisposition,
vitamin
D
deficiency,
hypermobility syndrome, and psychosocial factors. This
evolving perspective introduces new diagnostic
uncertainties as healthcare providers must differentiate
growing pains from serious underlying conditions, such
as infections, malignancies, and autoimmune disorders.
Communication with parents plays a critical role, as they
often seek immediate reassurance amid concerns about
their child's health. The integration of mental health
evaluations and tailored pain management strategies,
including non-pharmacological approaches, is essential
for effective treatment. Additionally, establishing
structured follow-up care can aid in monitoring
symptom progression and improving long-term
outcomes.
In conclusion, addressing growing pains requires a
holistic approach that encompasses both physical and
psychological aspects of care. By enhancing the
understanding of this condition and improving
communication and management strategies, pediatric
emergency care can better support children
experiencing growing pains and their families
INTRODUCTION
Growing pains, despite their benign reputation, remain
a source of considerable distress for children and their
families, often leading to recurrent visits to pediatric
emergency departments (1). First described in the 1820s
by French physician Duchamp, growing pains have long
puzzled the medical community due to their vague
symptomatology and lack of physical findings (2, 3).
Traditionally, the condition has been labeled as
idiopathic and benign, with an emphasis on skeletal
growth spurts as the primary cause (2). However,
despite decades of clinical encounters, the precise
etiology of growing pains remains elusive, and our
understanding of the condition is still evolving.
In classic descriptions, growing pains predominantly
affect children between the ages of 3 and 12, with
intermittent, often nocturnal pain episodes that
typically localize to the lower extremities (4). The pain
usually resolves by morning, and the physical
examination remains normal during non-symptomatic
periods. However, the lack of objective markers for
diagnosis can lead to anxiety for parents and
misinterpretation
by
healthcare
providers
(5).
Historically, these episodes were often dismissed as ‘just
growing pains,’ but modern pediatric practice requires a
more comprehensive evaluation to exclude more
serious conditions like juvenile idiopathic arthritis,
leukemia, or infections, all of which can present with
similar symptoms (4,5).
The literature in the latter half of the 20th century
largely focused on differentiating growing pains from
pathological causes of pain, emphasizing the importance
of a thorough clinical history and physical examination.
Early studies from the 1950s to the 1990s often referred
to growing pains as "benign nocturnal limb pain of
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childhood" and suggested that rapid growth and
overactivity during the day may predispose children to
these discomforts at night (2, 6). Yet, there was little
empirical evidence to support these claims, and the
theory of skeletal growth as a causative factor began to
be questioned (2, 6).
Recent studies have introduced new perspectives on the
etiology of growing pains, suggesting a multifactorial
basis
that
includes
genetic
predispositions,
environmental influences, and even psychosocial
components (4). Research in the past decade has linked
growing pains to vitamin D deficiency, a finding
supported by studies demonstrating that children with
low levels of vitamin D are more likely to experience
musculoskeletal pain (7). This discovery has shifted
some focus from the skeletal system to broader
nutritional and biochemical factors in the div (7).
Another emerging perspective involves the association
between growing pains and joint hypermobility (8).
Children with hypermobility are more prone to
experiencing growing pains, likely due to increased
stress on their musculoskeletal system during physical
activity (9). This connection adds a biomechanical
dimension to the understanding of growing pains,
diverging from the earlier notion that growth spurts
alone were responsible (8, 9).
Additionally,
psychological
factors
are
gaining
recognition in the literature as potential contributors to
growing pains (10). Studies have suggested that children
with growing pains are more likely to report higher
levels of emotional stress, anxiety, or mood
disturbances (11). These findings hint at the possibility
that growing pains may be, in part, a somatic
manifestation of psychological stress, paralleling
conditions like tension headaches or abdominal pain in
children (11). The recognition of this psychosomatic
component underscores the need for a holistic approach
to the management of growing pains, beyond simple
reassurance and physical examination.
Despite these evolving insights, challenges persist in
pediatric emergency care settings, where growing pains
often present in a manner that overlaps with more
severe pathologies. The absence of clear diagnostic
criteria, combined with the anxiety of parents and the
distress of children, frequently leads to extensive
—
and
sometimes unnecessary
—
diagnostic testing to rule out
serious conditions (12). This dynamic complicates the
management of growing pains and highlights the
ongoing need for clear guidelines in differentiating
benign musculoskeletal pain from other, more serious
causes.
This review aims to bridge the gap between traditional
understanding and new perspectives on growing pains,
with a focus on the challenges that pediatric emergency
care providers face. By integrating both historical and
contemporary literature, we seek to offer a more
nuanced understanding of the condition, explore
emerging etiological factors, and outline strategies for
effective management. Additionally, this review will
examine the psychosocial aspects of growing pains and
the implications for both diagnosis and treatment in
pediatric emergency settings.
Epidemiology and Clinical Presentation
Growing pains are a prevalent condition in pediatrics,
reported to affect approximately 10-20% of children
globally, with a slight male predominance (13). These
pains are characterized by bilateral, intermittent
discomfort, primarily localized to the thighs, calves, or
behind the knees, and typically occur in the late
afternoon or evening, often worsening at night. Children
usually describe the pain as aching or throbbing, and
while episodes can last from minutes to several hours,
they tend to resolve spontaneously by morning (2).
The episodic nature of growing pains, alongside the
absence of physical signs of inflammation
—
such as
swelling, redness, or restricted joint movement
—
poses
diagnostic challenges. Physical examinations conducted
during asymptomatic periods usually yield normal
findings (14). This symptomology often leads to under
diagnosis or misinterpretation of the condition. In
pediatric emergency settings, recurrent presentations of
growing pains can raise concerns for more serious
underlying conditions, such as juvenile idiopathic
arthritis, malignancies like leukemia, or infections like
septic arthritis and osteomyelitis (15, 16).
Etiology: A New Perspective
Historically, the etiology of growing pains has been
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elusive, with early theories attributing the condition to
rapid skeletal growth or overuse of muscles. These
simplistic models have since evolved, leading to a
multifactorial understanding that incorporates genetic
predispositions,
biomechanical
factors,
and
psychosocial influences (18).
Vitamin D Deficiency
Recent literature has highlighted a notable association
between growing pains and low levels of vitamin D, a
nutrient essential for calcium absorption and bone
health (19). Children presenting with growing pains had
significantly lower serum vitamin D levels compared to
healthy controls, suggesting that vitamin D deficiency
could compromise skeletal development and contribute
to pain. This finding resonates with earlier research
indicating that optimal vitamin D levels are vital for
musculoskeletal health, with deficiencies potentially
leading to conditions like rickets, which can manifest as
pain (19, 20).
Moreover, the seasonal variation of growing pains
—
often reported more frequently during the winter
months
—
has been correlated with lower sunlight
exposure and, consequently, reduced vitamin D
synthesis (21). This emerging link emphasizes the
importance of considering nutritional factors in the
evaluation and management of growing pains.
Psychosocial Factors
The role of psychosocial factors in growing pains has
garnered increasing attention in contemporary
research. Emotional stress, anxiety, and familial
dynamics have been identified as exacerbating elements
(22). Growing pains might represent a somatic
manifestation of psychological distress in children,
paralleling conditions such as tension headaches or
abdominal pain (23). Children with growing pains are
more likely to report symptoms of anxiety or mood
disturbances, indicating a potential need for
psychosocial screening in affected populations (24).
Moreover, family history plays a crucial role in
understanding the etiology of growing pains. Research
has shown that children with a family history of growing
pains are at a higher risk of developing the condition,
underscoring a possible genetic predisposition (24). This
familial clustering not only highlights genetic factors but
also suggests that environmental influences within the
home may contribute to the psychosocial aspects of the
condition.
Biomechanics and Overuse
The biomechanical perspective on growing pains
suggests that children with hypermobility or poor
posture may experience these pains more frequently.
Increased flexibility can lead to instability in the joints,
resulting in repetitive microtrauma to the muscles and
connective tissues during physical activity (9). There is a
significant correlation between joint hypermobility and
the prevalence of growing pains, emphasizing the need
for a careful assessment of physical activity patterns and
postural alignment in children presenting with pain (25).
Additionally,
overuse
injuries
from
increased
participation in sports and physical activities may
exacerbate the condition, particularly in active children.
Mechanical overload from repetitive stress could trigger
pain in susceptible individuals, particularly when
compounded by inadequate recovery (26). This
perspective shifts the focus from merely attributing pain
to growth spurts to considering the dynamic interplay
between
physical
activity
and
the
child's
musculoskeletal development.
Challenges in Pediatric Emergency Care
Differential Diagnosis
One of the most significant challenges pediatric
emergency departments (EDs) face is differentiating
growing pains from more serious pathologies. While the
absence of alarming features such as fever, weight loss,
joint swelling, or morning stiffness can be reassuring, it
remains critical for physicians to remain vigilant in ruling
out more severe conditions.
Infections:
Septic arthritis and osteomyelitis present
with localized pain, swelling, and systemic signs of
infection. A high index of suspicion is necessary when
evaluating children presenting with limb pain, as timely
diagnosis and management are crucial to prevent long-
term complications (27). Typical presentations of septic
arthritis include joint effusion and an inability to bear
weight, distinguishing it from growing pains.
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Malignancies:
Conditions such as leukemia and bone
tumors can present similarly, especially in their early
stages. Pediatric malignancies may manifest as
unexplained pain in the limbs, necessitating thorough
evaluation to exclude serious pathology (28). It is vital to
consider the patient’s overall clinical picture, including
other systemic symptoms like fatigue, pallor, and
bruising.
Autoimmune Disorders
: Juvenile idiopathic arthritis
(JIA) can also mimic the presentation of growing pains.
The American College of Rheumatology (ACR) guidelines
highlight the importance of recognizing specific clinical
features that differentiate JIA from benign growing
pains, such as morning stiffness and joint swelling (10).
Early recognition and treatment are crucial to prevent
joint damage and functional impairment.
The lack of specific diagnostic markers for growing pains
often leads to extensive and costly diagnostic workups,
including laboratory tests, X-rays, and MRI, to rule out
these conditions. Pediatric patients with growing pains
frequently undergo unnecessary imaging and lab tests,
contributing to increased healthcare costs and parental
anxiety (29).
Parental Anxiety and Communication
Growing pains can be a source of distress for both
children and their parents, often leading to frequent
visits to pediatric emergency care. Parents frequently
seek immediate answers and reassurance, which can
pose a challenge for healthcare providers (25). The
benign nature of growing pains can make it difficult to
provide clear explanations, especially when more
serious conditions need to be ruled out.
Parents of children with unexplained pain often
experience heightened anxiety, fearing the worst.
Effective communication is essential in these scenarios.
Physicians must be skilled in conveying the concept of a
diagnosis of exclusion, providing education about the
self-limiting nature of growing pains, and offering
reassurance without dismissing parental concerns.
Employing shared decision-making strategies and
providing educational materials can significantly
alleviate parental anxiety and improve satisfaction with
care (30).
Over-treatment and Unnecessary Investigations
The overlap in symptomatology between growing pains
and serious conditions contributes to the challenges of
over-investigation and over-treatment in pediatric
emergency care. As growing pains are a diagnosis of
exclusion, the imperative to rule out serious pathologies
often leads to unnecessary diagnostic imaging, blood
tests, and referrals to specialists. Unnecessary
investigations not only add to healthcare costs but can
also contribute to increased parental anxiety and
discomfort for the child (31).
Healthcare providers must balance the need to rule out
serious conditions with the necessity of avoiding
unnecessary investigations. Developing standardized
protocols for the evaluation of limb pain in pediatric
patients may help streamline care and reduce
unwarranted interventions. This collaborative approach,
involving both pediatric emergency clinicians and
primary care providers, can ensure appropriate follow-
up and management of these cases, ultimately
enhancing patient care.
Pain Management
There is no definitive treatment for growing pains, and
management strategies primarily focus on alleviating
symptoms. The following approaches are commonly
employed:
Nonsteroidal Anti-inflammatory Drugs (NSAIDs):
NSAIDs, such as ibuprofen and acetaminophen, are
often effective for pain relief. However, their use must
be carefully considered in young children due to
potential side effects, including gastrointestinal
discomfort and renal complications (32).
Massage and Stretching Exercises:
Gentle massage and
stretching exercises targeting the affected limbs can
provide symptomatic relief. Implementing a regimen of
stretching exercises can significantly reduce the
frequency and intensity of growing pains in affected
children (17). These non-pharmacological interventions
should be encouraged as part of a holistic management
approach.
Warm Compresses:
Application of heat, such as warm
compresses, can also provide symptomatic relief,
particularly when used before bedtime. Anecdotal
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evidence suggests that heat therapy may help to relax
muscles and alleviate discomfort (17). Parents can be
educated on the safe application of heat therapy to
enhance comfort during episodes of pain.
While managing growing pains, healthcare providers
must also consider non-pharmacological methods,
including reassurance and education about the self-
limiting nature of the condition. However, challenges
persist in tailoring pain management approaches based
on individual child needs and responses. Factors such as
age, pain intensity, and psychosocial background can
influence
treatment
efficacy,
necessitating
a
personalized approach to care.
Emerging Challenges
With the evolving understanding of the etiology of
growing pains, several new challenges have surfaced in
pediatric emergency care, highlighting the need for a
more nuanced approach to diagnosis and management.
Healthcare practitioners face the challenge of
integrating these new variables into their diagnostic
frameworks while maintaining a balance between
thoroughness and efficiency in busy emergency
environments.
Mental Health Correlations
Emerging
research
increasingly
highlights
the
psychological aspects of growing pains, correlating them
with underlying mental health issues such as anxiety and
stress (14). Studies indicate that children experiencing
recurrent pain may also be dealing with psychosocial
factors that exacerbate their symptoms. Children with
chronic pain conditions often exhibit elevated levels of
anxiety, which can complicate symptom presentation
and management (33).
Longitudinal Follow-up
Given the recurrent nature of growing pains, there is an
increasing call for structured follow-up care. This can
help monitor symptom progression and ensure timely
interventions when necessary. Many children with
growing pains experience symptoms that persist or
recur, highlighting the need for longitudinal follow-up
(8, 10, 12).
However, emergency departments are typically not
equipped for long-term management, presenting a
significant challenge. The lack of established protocols
for follow-up care often results in fragmented
treatment, where children may receive sporadic
evaluations without comprehensive oversight.
Moreover, integrating care with primary care providers
or specialists in pediatric rheumatology can help bridge
this gap, but barriers such as limited access to specialty
care and communication challenges between providers
can hinder effective collaboration. Figure 1 represents
visual representation of the systematic approach to
managing growing pains in children, highlighting key
steps and consideration.
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Figure 1: Visual representation of the systematic approach to managing growing pains in children
CONCLUSION
Growing pains represent a common yet often
misunderstood condition in pediatric populations,
significantly impacting the lives of children and their
families. As our understanding of the etiology of growing
pains evolves, it is clear that this condition is
multifactorial, influenced by biological, psychosocial,
and environmental factors. The recent associations with
vitamin D deficiency, hypermobility syndrome, and
psychological distress necessitate a comprehensive
approach to diagnosis and management in pediatric
emergency care settings.
Key challenges remain in differentiating growing pains
from more serious underlying conditions, which often
leads to extensive diagnostic workups that may not be
warranted. Effective communication with parents is
crucial, as they frequently seek immediate reassurance
and clarity regarding their child's condition. Educating
families about the benign and self-limiting nature of
growing pains can help alleviate anxiety and reduce
unnecessary emergency department visits.
Moreover, the integration of mental health assessments
into routine evaluations is vital, considering the
psychological factors that may exacerbate symptoms.
Developing collaborative care models that include
multidisciplinary teams can significantly enhance the
management of growing pains and ensure that children
receive holistic support tailored to their individual
needs.
Finally, establishing structured follow-up care is
essential for monitoring symptom progression and
addressing any ongoing concerns. This may require
fostering closer ties between pediatric emergency
departments, primary care providers, and specialty
clinics to ensure continuity of care.
In conclusion, a nuanced understanding of growing
pains, combined with effective communication
strategies and a collaborative approach to care, can
improve outcomes for affected children. Future
research should continue to explore the complex
interactions of physiological, psychological, and
environmental factors contributing to growing pains,
paving the way for more effective management
strategies and better quality of life for pediatric patients.
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