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Akal F, Batu ED, Sonmez HE, Karadağ ŞG, Demir F, Ayaz NA, Sözeri B. Diagnosing growing pains in children by using machine learning: a cross-sectional multicenter study. Med Biol Eng Comput 2022; 60:3601-3614. [DOI: 10.1007/s11517-022-02699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/02/2022] [Indexed: 11/11/2022]
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O'Keeffe M, Kamper SJ, Montgomery L, Williams A, Martiniuk A, Lucas B, Dario AB, Rathleff MS, Hestbaek L, Williams CM. Defining Growing Pains: A Scoping Review. Pediatrics 2022; 150:e2021052578. [PMID: 35864176 DOI: 10.1542/peds.2021-052578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Up to one third of children may be diagnosed with growing pains, but considerable uncertainty surrounds how to make this diagnosis. The objective of this study was to detail the definitions of growing pains in the medical literature. METHODS Scoping review with 8 electronic databases and 6 diagnostic classification systems searched from their inception to January 2021. The study selection included peer-reviewed articles or theses referring to "growing pain(s)" or "growth pain(s)" in relation to children or adolescents. Data extraction was performed independently by 2 reviewers. RESULTS We included 145 studies and 2 diagnostic systems (ICD-10 and SNOMED). Definition characteristics were grouped into 8 categories: pain location, age of onset, pain pattern, pain trajectory, pain types and risk factors, relationship to activity, severity and functional impact, and physical examination and investigations. There was extremely poor consensus between studies as to the basis for a diagnosis of growing pains. The most consistent component was lower limb pain, which was mentioned in 50% of sources. Pain in the evening or night (48%), episodic or recurrent course (42%), normal physical assessment (35%), and bilateral pain (31%) were the only other components to be mentioned in more than 30% of articles. Notably, more than 80% of studies made no reference to age of onset in their definition, and 93% did not refer to growth. Limitations of this study are that the included studies were not specifically designed to define growing pains. CONCLUSIONS There is no clarity in the medical research literature regarding what defines growing pain. Clinicians should be wary of relying on the diagnosis to direct treatment decisions.
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Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Steven J Kamper
- Centre for Pain, Health and Lifestyle, New South Wales, Australia
- School of Health Sciences
- Nepean Blue Mountains Local Health District, Penrith, Australia
| | - Laura Montgomery
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Amanda Williams
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales, Australia
| | - Alexandra Martiniuk
- School of Public Health, Faculty of Medicine, and Health
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
- Dalla Lana School of Public Health, The University of Toronto, Ontario, Canada
| | - Barbara Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School
- John Walsh Center for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Physiotherapy Department, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | | | - Michael S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, Clinical Biomechanics, University of Southern Denmark, Campus vej 55, 5230, Odense, Denmark
- The Chiropractic Knowledge Hub, Odense, Denmark
| | - Christopher M Williams
- Centre for Pain, Health and Lifestyle, New South Wales, Australia
- Hunter New England Population Health Unit, Newcastle, Australia
- University of Newcastle, Callaghan, Australia
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Li H, Wang B, He L, Tao R, Shang S. Application of bone metabolic parameters in the diagnosis of growing pains. J Clin Lab Anal 2021; 36:e24184. [PMID: 34952997 PMCID: PMC8842154 DOI: 10.1002/jcla.24184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The present study aimed to assess the diagnostic significance of serum bone metabolic parameters in children with growing pains (GPs). Methods All patients diagnosed with GP and healthy controls matched with age and gender were recruited at the outpatient clinic of Children's Hospital at Zhejiang University School of Medicine from August 2016 to August 2021. In all subjects, serum levels of calcium (Ca), phosphorus (P), procollagen type‐I N‐terminal (PINP), parathormone (PTH), 25‐hydroxyvitamin D (25‐(OH)D), osteocalcin (OC), N‐terminal cross‐linked telopeptides of type‐I collagen (CTX), and tartrate‐resistant acid phosphatase type 5b (TRACP5b) were investigated. The univariate analysis, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curve were used to identify the bone metabolic parameters factors for diagnosing GP. Results We enrolled 386 children with GP and 399 healthy controls in present study. The mean age of GP group was 5.319 years, and, primarily, the subjects were preschool‐age children. The gender ratio (male‐to‐female) was 1.27 in GP group. After adjusting for age and gender, we identified that the serum levels of Ca (p < 0.001, OR: 25.039), P (p = 0.018, OR: 2.681), PINP (p < 0.001, OR: 1.002), and PTH (p = 0.036, OR: 0.988) were independent diagnostic factors associated with GP. Area under curve (AUC) of the ROC curves was in the order: PINP (0.612) > Ca (0.599) > P (0.583) > PTH (0.541). A combination of independent diagnostic factors and multivariable logistic regression analysis provided a refined logistic regression model to improve the diagnostic potential, of which the AUC had reached 0.655. Conclusions Serum levels of Ca, P, PINP, and PTH could be independent diagnostic factors associated with GP. The logistic model was significantly superior to bone metabolic parameters for diagnosing GP.
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Affiliation(s)
- Huamei Li
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Bing Wang
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Lin He
- Zhejiang University School of Medicine, Hangzhou, China
| | - Ran Tao
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Shiqiang Shang
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
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Barbagallo M, Sacerdote P. Ibuprofen in the treatment of children's inflammatory pain: a clinical and pharmacological overview. Minerva Pediatr 2019; 71:82-99. [PMID: 30574736 DOI: 10.23736/s0026-4946.18.05453-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Unlike fever, which is often over-treated especially in children, pain is underestimated and under-treated in pediatric age. The pharmacological agents approved for treating pain in these patients are few, also considering the recent limitation for codeine in children younger than 12 years. Paracetamol and the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen are the most used at this purpose. The aim of this overview was to analyze the therapeutic appropriateness of ibuprofen in children based on its pharmacological properties. This work is a critical review of the pediatric literature over the last 20 years on efficacy and adverse events associated with the use of ibuprofen as analgesic in the pediatric population. Ibuprofen resulted effective in several pain conditions in children such as musculoskeletal pain, ear pain and acute otitis media, toothache and the inflammatory disease of the oral cavity and pharynx. The drug is a reasonable and efficacious alternative in postoperative pain, including tonsillectomy and adenoidectomy. It remains the treatment of choice for pain in chronic inflammatory diseases such as arthritis. Side effects and adverse events associated with ibuprofen are mild. It has the lowest gastrointestinal (GI) toxicity among NSAIDs, although some cases of GI toxicity may occur. Its renal effects are minimal, but dehydration plays an important role in triggering renal damage, so ibuprofen should not be given to patients with vomiting and diarrhea. Ibuprofen showed a good safety profile and provided evidence of effectiveness for mild-moderate pain of different origin in children. In case of fever or pain, the choice about the drug to be used should fall on ibuprofen in a clinical context where there is an inflammatory pathogenesis.
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Affiliation(s)
- Massimo Barbagallo
- Department of Pediatrics, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione "Garibaldi", Catania, Italy -
| | - Paola Sacerdote
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
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Kanta P, Gopinathan NR. Idiopathic Growing Pains in Pediatric Patients: Review of Literature. Clin Pediatr (Phila) 2019; 58:5-9. [PMID: 29962219 DOI: 10.1177/0009922818784956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Poonam Kanta
- 1 Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Chronic musculoskeletal pain (CMP) is one of the main reasons for referral to a pediatric rheumatologist and is the third most common cause of chronic pain in children and adolescents. Causes of CMP include amplified musculoskeletal pain, benign limb pain of childhood, hypermobility, overuse syndromes, and back pain. CMP can negatively affect physical, social, academic, and psychological function so it is essential that clinicians know how to diagnose and treat these conditions. This article provides an overview of the epidemiology and impact of CMP, the steps in a comprehensive pain assessment, and the management of the most common CMPs.
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Affiliation(s)
- Jennifer E Weiss
- Pediatric Rheumatology, Seton Hall School of Medicine, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Jennifer N Stinson
- Research Institute, Child Health Evaluative Sciences, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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Beyitler I, Kavukcu S. Approach to Growing Pains in Childhood in a Familial Mediterranean Fever Endemic Region. IRANIAN JOURNAL OF PEDIATRICS 2017; 27. [DOI: 10.5812/ijp.11546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Jenssen BP, Lautz AJ, Orthmann-Murphy JL, Yum SW, Waanders A, Fox E. A 6-Year-Old With Leg Cramps. Pediatrics 2015; 136:732-9. [PMID: 26371189 DOI: 10.1542/peds.2015-0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 11/24/2022] Open
Abstract
A 6-year-old girl presented with a history of leg pain and cramping that progressively worsened over a 2- to 3-week period of time. Her examination was notable for normal vital signs, limited range of motion of her left hip, and a limp. Inflammatory markers were slightly elevated, but the serum electrolytes, calcium, and magnesium, complete blood cell count and differential, and creatine kinase level were normal. She was hospitalized for further diagnostic evaluation and was noted to have abnormal muscle movements classified as myokymia (continuous involuntary quivering, rippling, or undulating movement of muscles). Electromyography confirmed the myokymia but did not reveal evidence of a myopathy or neuropathy, prompting additional evaluation for a systemic etiology.
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Affiliation(s)
- Brian P Jenssen
- Departments of Pediatrics, and Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and University of Pennsylvania, Robert Wood Johnson Foundation Clinical Scholar Program, Philadelphia, Pennsylvania
| | - Andrew J Lautz
- Departments of Pediatrics, and Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Jennifer L Orthmann-Murphy
- Departments of Pediatrics, and Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Sabrina W Yum
- Departments of Pediatrics, and Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Angela Waanders
- Departments of Pediatrics, and Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Elizabeth Fox
- Departments of Pediatrics, and Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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Lee HJ, Lim KB, Yoo J, Yoon SW, Jeong TH. Effect of foot orthoses on children with lower extremity growing pains. Ann Rehabil Med 2015; 39:285-93. [PMID: 25932426 PMCID: PMC4414976 DOI: 10.5535/arm.2015.39.2.285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/02/2014] [Indexed: 11/07/2022] Open
Abstract
Objective To evaluate the effect of custom molded foot orthoses on children with growing pains of the lower extremities. Methods Children with growing pains were recruited during a clinic visit. None had any bony deformities, inflammatory joint disease or depression. Resting calcaneal stance position (RCSP) and calcaneal pitch angle were measured, and individual custom molded rigid foot orthoses were prescribed using the inverted orthotic technique to control for foot overpronation using the RCSP angle. Pain sites, degree and frequency of pain, and balance ability were evaluated using Balance Master computerized posturography prior to foot orthosis fitting, and 1 and 3 months later. Results Twenty children completed the study. Seventeen (75%) had overpronated feet. Significant improvements were noted after 1 and 3 months in pain degree and frequency, and after 3 months in balancing ability. Conclusion The use of custom molded foot orthoses is a good method for treating children with multiple musculoskeletal pains in the leg.
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Affiliation(s)
- Hong-Jae Lee
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kil-Byung Lim
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - JeeHyun Yoo
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sung-Won Yoon
- Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Tae-Ho Jeong
- Institute of Sports Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea
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Abstract
NEED AND PURPOSE OF REVIEW Though cases of 'growing pains' are quite common in pediatric practice, very little attention has been given to it, even in the standard text books. The resultant confusion among practitioners regarding diagnosis and management of this condition needs to be addressed. METHODS USED FOR LOCATING, SELECTING, EXTRACTING AND SYNTHESIZING DATA PubMed search was performed using "growing pains "[All Fields] AND (("child"[MeSH Terms] OR "child"[All Fields] OR "children"[All Fields]) AND ("pediatrics"[MeSH Terms] OR "pediatrics"[All Fields] OR "pediatric"[All Fields])). Types of articles included are Review articles, Systemic Reviews, Randomized Controlled Trials, Practice guidelines and Observational studies. Google Scholar was also searched using the term "Growing pains in children". Relevant articles not included in the PubMed results were selected. Reference lists of selected studies were also screened to identify additional studies. MAIN CONCLUSIONS A fairly accurate diagnosis of growing pains can be made clinically, if the widely accepted diagnostic criteria are followed . A systematic approach, with due consideration of both inclusion as well as exclusion criteria, can avoid unnecessary (sometimes potentially harmful) investigations and medications. Reassurance remains the main stay in the management of 'growing pains'.
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Crayne CB, Gomez R, Gedalia A. A 14-year-old with diffuse musculoskeletal pain. Clin Pediatr (Phila) 2015; 54:299-301. [PMID: 25305260 DOI: 10.1177/0009922814553423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ricardo Gomez
- Children's Hospital, New Orleans, LA, USA Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Abraham Gedalia
- Children's Hospital, New Orleans, LA, USA Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Bout-Tabaku S, Klieger SB, Wrotniak BH, Sherry DD, Zemel BS, Stettler N. Adolescent obesity, joint pain, and hypermobility. Pediatr Rheumatol Online J 2014; 12:11. [PMID: 24678578 PMCID: PMC3973833 DOI: 10.1186/1546-0096-12-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/19/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Obesity associated with joint pain of the lower extremities is likely due to excessive mechanical load on weight bearing joints. Additional mechanical factors may explain the association between obesity and joint pain. FINDINGS We characterized the association between obesity and non-traumatic lower extremity (LE) joint pain in adolescents and examined the modifying effect of hypermobility on this association.We performed a cross-sectional analysis of data from subjects enrolled in a clinical trial examining the impact of weight loss on bone health in adolescents. Anthropometric data were collected and body mass index (BMI = kg/m2) was calculated. Subjects were categorized as obese or healthy weight controls based on CDC 2000 growth curves for age and gender. We assessed any musculoskeletal pain and LE pain by the PEDS™ Pediatric Pain Questionnaire™. Hypermobility was assessed with the modified Beighton scoring system. Multivariate logistic regression models adjusted for covariates were performed to examine the association between weight status and joint pain.Out of 142 subjects, 91 were obese and 51 were healthy weight. Obesity was not associated with any musculoskeletal pain (OR 0.86, CI 0.49-1.50), LE pain (OR 1.02, CI 0.49-2.15) or hypermobility (OR 1.23, CI 0.72-2.14, p = 0.3). There was no effect modification on the association between obesity and any musculoskeletal pain (OR 0.80, CI 0.45 -1.42) or LE pain (OR 0.98, CI 0.46 - 2.08) by hypermobility status. CONCLUSIONS We found no association between LE pain and obesity, and hypermobility did not modify this association.
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Affiliation(s)
- Sharon Bout-Tabaku
- Department of Pediatrics, Division of Rheumatology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA.
| | - Sarah B Klieger
- Department of Pediatrics, Division of Infection Diseases, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Brian H Wrotniak
- Department of Physical Therapy, D’Youville College, Buffalo, USA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - David D Sherry
- Department of Pediatrics, Division of Rheumatology, The Children’s Hospital of Philadelphia, Philadelphia, USA,University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Babette S Zemel
- Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, USA,University of Pennsylvania School of Medicine, Philadelphia, USA
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Modica RF, Sukumaran S, Milojevic D. Pediatric musculoskeletal examination for juvenile arthritis. Pediatr Ann 2012; 41. [PMID: 23152981 DOI: 10.3928/00904481-20121022-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Renee F Modica
- Pediatric Rheumatology, University of Florida, 1600 SW Archer Road, R118-G, Box 100296, Gainesville, FL 32610-0296, USA.
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