The mother of a four year old girl brings her to the office with the chief complaint that for the past three nights the child has awaken from sleep with pains in her legs. Your exam is normal.. How should you further evaluate this patient?

Growing pains are a common pediatric disorder with an incidence of about 15%. It is most common from 3-5 years of age, but may be seen up to 9 years of age. There is a greater incidence in girls.

Symptoms usually are pains that occur at the end of the day or awaken the child from sleep. Most often the pains are bilateral and usually localized to the thighs or calves and do not involve the joints. Rarely, there may be pains in an upper extremity. The symptoms do not interfere with activities during the daytime. The symptoms are intermittent with periods of days or weeks without any pain.

Physical examination is normal without any evidence of trauma, joint swelling, erythema, decreased range of motion, limp, or tenderness. Evaluations, including radiographs and ESR, are normal.

Symptoms may last up to two years.

1. There are many theories but no known etiology has been proven.
   
2. Fatigue?
   
3. Emotional?- need for secondary gains from attention generated by complaints
   
4. Not related to growth because the growth rate actually slows down during the peak incidence of when symptoms arise. Also, children with symptoms have the same growth velocity as those without pains.
   
5. Highly likely there is an organic basis and metabolic by-products of muscle metabolism are responsible

1. Hypermobility Syndrome- pain usually in the joint.
   
2. Nocturnal cramps- parent may feel a tightness in the muscle.
   
3. Ostoid osteoma- benign tumor with night time pain in the bone. Radiograph may be normal but bone scan may show abnormality. Very sensitive to ASA

1. This is a benign condition and no specific treatment is necessary
   
2. Rubbing the extremity and mild analgesics may help
   
3. Some evidence that stretching the muscles may prevent pains although this may be secondary to attention given to the problem
   
4. Reassurance, stressing the benign prognosis and absence of sequelae.

1. Szer, Ilona. Are those limb pains "growing" pains. Contemporary Pediatrics. March 1989