Growing Pains: When Should Parents Worry?

Like mumps and measles, growing pains are a rite of passage, a sign of growing up. Most parents take it in stride. "It's just growing pains," they tell their crying child.

But what exactly are these pains? Why do some kids get severe pain, while others get none? Could the pain mean something is really wrong? How can parents know?

Growing pains typically occur between ages 3 and 7. Doctors say the pain is triggered when bones grow, stretching the bone's thick covering, explains Larry Vogler, MD, a pediatric rheumatologist at Emory University School of Medicine in Atlanta.

According to the American Academy of Pediatrics, these pains have been linked to particularly active days and not growth. Growing pains are real discomforts for many children; often growing pains can awaken children from sleep.

Some kids are predisposed to getting growing pains. If dad had them, his child will, too. The pains seem most intense after a day of vigorous jumping and running. Kids typically feel the pains at night, then they disappear in the morning. "Be reassuring, give a massage, and give Tylenol with a little food if you think you need to," Vogler tells ishonest.

If your child develops certain symptoms, it's wise to notify your child's doctor. Worrisome symptoms that might indicate that something other than growing pains and something more serious may be going on include:

• Persistent pain, pain in the morning or swelling, tenderness, and redness in a joint
• Joint pain associated with an injury
• Limping, weakness, or unusual tiredness

If a child wakes up in the morning with leg pains -- then feels relief after moving around -- it may be juvenile rheumatoid arthritis (JRA), says Thomas J. A. Lehman, MD, chief of pediatric rheumatology for the Hospital for Special Surgery at Weill Medical College of Cornell University. Lehman is the author of It's Not Just Growing Pains.

"Those pains need to be investigated by a doctor," Lehman tells ishonest. "They should not be simply dismissed. It may not be anything serious, but it needs to be evaluated."

Arthritis Often Missed

Lehman regularly sees young patients with all types of arthritis, but especially juvenile rheumatoid arthritis. It's an unpredictable disease with symptoms that can worsen or disappear without clear reason, he explains. In general, children with JRA have one or several symptoms including joint pain, joint swelling, and joint stiffness early in the disease. Most children have good and bad days.

He's seen it too many times: "Virtually every child with arthritis has been dismissed as 'just having growing pains,'" Lehman tells ishonest. "And because proper diagnosis is delayed -- sometimes for months -- there are irretrievable circumstances."

Most children with juvenile rheumatoid arthritis (70% to 90% of them) will recover without any serious disabilities. But some symptoms can continue into adulthood, such as stiffness, pain, limits on physical activity, and chronic arthritis.

In the worst cases, the length of the child's leg can be affected. That happens when inflammation in an untreated joint increases blood flow in that joint, he explains. "With that increased blood flow, the bone will grow bigger. One leg will actually be longer than the other. It can affect walking, [and] cause hip and back problems."

"The whole key is to understand what growing pains are, and what they aren't," says Lehman. "A child with growing pains will have no daytime pain, no limp, no other abnormality. But when the child gets pain during the day -- and the pains are persistent or abnormally severe -- the child needs to see a doctor."

Often, children with JRA are mistakenly sent to an orthopaedic surgeon, Vogler tells ishonest. "If the pain is misinterpreted as a hairline fracture, the child gets a cast. With JRA, immobilizing the joint is counterproductive. The treatment should involve anti-inflammatory medications and working on regaining lost range of motion."

For most kids, getting spoiled by late-night attention is the biggest problem with true growing pains, Vogler explains. "The growing pains take on a life of their own. Children find out that crying at night gets mom's attention, and it becomes positive reinforcement. Parents need to be aware that most kids with growing pains don't have them every single night. It's fine to reassure, but don't overindulge."

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