Sometimes our children complain of pain in their legs that appear late in the afternoon.. “That's because you're growing” they are often told.. But, is that true? Does it hurt because they get older?? Does growing up hurt?

Growing pains are often described as a throbbing, a sensation of stabbing pain in the legs, often on the front of the thighs, the calves or behind the knees. They tend to affect both legs and occur at night, and can even wake up boys and girls who suffer from them.

When in doubt, parents should consult with the pediatrician, but in these lines we will try to summarize what is known about this clinical picture., how to identify it, treat it and most importantly, knowing how to detect those signs and/or symptoms that make us go to your doctor sooner.
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The first thing to mention is that although these pains are called growing pains, there is no evidence that growth hurts.

Another interesting point is to remember that not all types of leg pain in children correspond to this picture.. Sometimes, leg pain can be caused by other conditions and needs to be differentiated.

It is also interesting to know that some children may experience abdominal pain or headache during episodes of growing pains..

Why does it happen?
The causes currently considered are physical fatigue, disorders in anatomical alignment or emotional problems. However, there is no consensus in the literature on why this occurs.. We do know that the natural history of this pathology usually presents a decrease in the frequency and intensity of pain in 12 a 24 months with occasional relapses even during the adolescent stage.

Which boys and girls are most affected??
Growing pains can begin in preschool age with ages between 3 y 5 years. Some authors refer to the age of the 4 and the 6 (37% of the population of these ages); Others talk about the ages between 8 y 12 years as those with the highest incidence of pain.
Some authors believe that there is a decrease in the growth rate among 4 y 12 years of age to spike in adolescence and coincides with the highest incidence of growing pains at this age.

Regarding sex, it seems that boys are more prone than girls, although it is not entirely clear and the sporting activity that presents the highest risk of developing pain is football.. An interesting fact is that obesity has a high correlation with the presence of growing pains above and beyond sports practice., Therefore, it should be taken into account as a probable risk factor for this pathology.. It seems that some authors also talk about the appearance of poor alignment in the lower limbs., especially the knees, related to overweight (genu valgo) and they relate them to the appearance of these pains. In some texts, flat feet are given importance, while in others not.

What characteristics do these paintings have??
They appear in the afternoon or at night.
They are intermittent, (they come and go).
They disappear with rest and allow the boy or girl to lead a normal life.
It is not on a joint, (hip, knee or ankle), but on the front of the thigh, calf or behind the knee.
They are not associated with any previous injury, trauma, blow or symptoms of fever or general malaise.
It appears isolated, that is to say, no redness, swelling, discomfort, fever, skin rashes, etc.

Therefore, We will suspect another origin of the symptoms and therefore we will go to the pediatrician sooner if it is the same.:
Persevering
Still present in the morning
The pain is severe enough to interfere with the child's normal activities.
Located in the joints.
It occurs associated with an injury or trauma.
It is accompanied by other signs or symptoms, like swelling, redness, sensitivity, fever, limp, skin rash, loss of appetite, weakness or fatigue.

The pediatrician will determine if it is growth pain and in this case the physiotherapist will be the specialist in carrying out the treatment together with the parents who must know the guidelines to follow and accompany their child in carrying them out..

The pediatrician will diagnose the condition with a clinical interview and may perform a complementary test such as a blood test or an x-ray., to differentiate from other conditions such as trauma, viral diseases, overuse syndromes, hypermobility, mainly.

What is your treatment?
Once diagnosed, The pediatrician may recommend taking a drug for inflammation..

If the origin is due to fatigue, mechanical alteration or bone growth, The physiotherapist will be the indicated professional to carry out the treatment, which will be based on a diagnosis of the cause of the symptoms and will develop, together with the parents and the child, guidelines that adjust to the needs and possibilities of the family, among which therapeutic exercise such as stretching will stand out, and the use of some means for pain relief among which pain education will be key, ( know how our body and pain behave and what is happening in it).
The need to stop doing physical exercise that the boy or girl likes is not described, but it is possible for the physiotherapist to speak with the trainer or physical trainer to agree on some measures for the duration of the treatment..

In this sense, the role of the podiatry professional could be very useful if the pediatrician and/or the physiotherapist detect any possible alteration of the step or gait..

The nutritionist will be decisive in case the boy or girl has a high body mass index and could be a risk factor..

Finally, Having a psychologist would be necessary if it has an emotional origin.

Teamwork, both of the named professionals, as well as the family will be key in improving the symptoms of this condition whose natural history is resolution and does not create any other problem but must be correctly diagnosed and evaluated..


References:
“Growing pains: contemporary knowledge and recommended practice”. Angela M Evans.
“Somatosensory test responses in children with growing pains”. Pathirana S.