"Growing pains": clinical and behavioral correlates in a community sample

An exploration of clinical features and factors associated with pain frequency and pain intensity in children with growing pains: a cross-sectional study from Chongqing, China

Instruction

Growing pains are the most common cause of musculoskeletal pain in children, affecting both children's and caregivers' well-being. The lack of definitive diagnostic criteria complicates diagnosis and treatment.

Objectives

This study aims to outline the clinical features and identify factors associated with the frequency and intensity of growing pains in children in Chongqing, China.

Methods

A cross-sectional study was conducted in a children's hospital using its Internet hospital follow-up platform. Children initially diagnosed with growing pains between July and September 2022 were enrolled. Sociodemographics, pain locations, duration, frequency, intensity, and potentially related factors were collected.

Results

Eight hundred sixty-three children were enrolled (average age: 8.19 ± 3.24 years; 455 boys [52.72%]). Pain frequency was reported as quarterly (62.11%), monthly (24.80%), biweekly (1.74%), weekly (10.08%), and daily (1.27%). The prevalence of mild, moderate, and severe pain was 26.65%, 55.74%, and 17.61%, respectively. The knee was the most common pain location (63.85%), mostly encountered between 4 pm and 5 pm (20.51%). Multivariate analysis revealed that pain frequency negatively correlated with vitamin supplementation during pregnancy, positively correlated with underweight, bad temper, increased exercise, and cold lower extremities. Pain intensity positively correlated with irritability, increased exercise, and pain sensitivity but negatively correlated with age and vitamin supplementation during lactation.

Conclusion

Growing pains typically occur on a quarterly basis, predominantly affecting the knees during 4 pm to 5 pm. Factors in sociodemographics, maternal aspect, temperament, and exercise levels can influence pain frequency and intensity. Clinicians should consider these aspects when developing comprehensive strategies for pain management.

Growing pains in Danish preschool children: a descriptive study

This study provides a detailed description of growing pains in young Danish children as standardized diagnostic criteria are needed to avoid misclassifications of other musculoskeletal diagnoses. The study is nested in a cohort study of Danish preschool children. At baseline, parents completed a questionnaire with sociodemographic information. During the study, the parents received a text message every two weeks inquiring about musculoskeletal pain in the child. If pain was reported, a telephone interview about pain characteristics was conducted. The present study includes data from 2016 to 2019 with 777 children, aged 3-6 years of age at baseline. The prevalence of growing pains was 24-43%, depending on the definition. The pain occurred most frequently 1-3 times per week and most commonly in the lower legs, could be unilateral or bilateral and was usually without consequences. The prevalence increased with age, and there were no consistent associations with socio-economic factors. We suggest using Evan's criteria with the addition of unilateral pain as standard diagnostic criteria in the future. We found no relation to periods of rapid growth and suggest that the term is a misnomer. Etiology and long-term courses of pain need to be explored in future studies.

Clinical, laboratory characteristics and growth outcomes of children with growing pains

Growing pains (GP), a common and benign pain syndrome of unknown etiology, is characterized by bilateral recurrent leg pain in childhood. There are no standardized diagnostic criteria for GP, and the diagnosis is often made by exclusion. To identify clinical and laboratory features, we included patients < 12 years with GP at National Taiwan University Children's Hospital between April 2006 and April 2019 in a retrospective study. We also compared body weight and body height z-scores between diagnosis and up to 2 years post-diagnosis to determine if rapid growth was associated with GP. This cohort study included 268 patients with a mean age of 4.7 ± 2.2 years. The most common features of GP were bilateral leg pain, no limitation of activity, intermittent pain, normal physical examination, and being well physically. The average number of Walters' criteria fulfilled by the patients with GP was 6.7 ± 0.9. Elevated serum levels of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were observed in 37.5% and 15.6% of patients, respectively. Symptomatic medications were used in 33% of patients. Our study indicates that ALP and LDH may be biomarkers associated with GP. There was no significant association between GP and rapid growth within 2 years of diagnosis.

Defining Growing Pains: A Scoping Review

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.

Overlapping features of restless legs syndrome and growing pains in Turkish children and adolescents

BACKGROUND

Restless legs syndrome (RLS) and growing pains (GPs) share many common features and are sometimes overlapping diagnoses. The present study aims to investigate the shared features of patients with RLS, classified based on the 2013 diagnostic criteria of International Restless Legs Syndrome Study group and of patients with GPs, diagnosed based on the combined criteria proposed in 2013.

METHODS

A cross-sectional population study was conducted in 7 Istanbul schools, which were selected randomly. A total of 4565 (56.1% female) children aged 9 to 18 years were included. In the first stage, candidates of RLS and GPs were identified based on 2 separate questionnaires, whose diagnoses were confirmed by a second survey applied to them under parental supervision.

RESULTS

Out of 192 children (65.6% female) diagnosed as definite RLS (yearly prevalence: 4.2%), 30 (15.6%) reported bilateral leg muscle pain localized typical regions for GPs, which started <13 years of age in 17 children. An urge to move the legs to relieve unpleasant sensations or pain was present in 39.3% of 140 children (64.3% female) classified as GPs (yearly prevalence: 3.1%). Occurrence of symptoms at rest or when lying down was present in 36.4% of GPs children and relief by gross movements was in 21.4% children. Only 12 patients (9 with definite RLS and 3 with GPs) (0.03% of total cohort) were eligible for overlapping diagnosis of GPs and RLS.

CONCLUSION

Although a considerable number of patients with RLS and GPs share some clinical features, a combined phenotype is very rare.

Growing pains: What do we know about etiology? A systematic review

BACKGROUND

Growing pains is the most common cause of musculoskeletal pain in early childhood and was first described in 1823 by French physician Marcel Duchamp. Although it has been researched extensively, the etiology is still unknown. Several theories have been proposed throughout the years.

AIM

Analyze the available scientific literature to provide an update on the latest evidence on the etiology.

METHODS

According to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the scientific literature on the etiology of growing pains was systematically reviewed using the following inclusion criteria: studies of any level of evidence reporting clinical or preclinical results and dealing with the etiology of growing pains. The medical electronic databases PubMed and Web of Science were searched by two independent authors on October 20, 2018. The search string used was “(growing pains OR benign nocturnal limb pains OR musculoskeletal pains) AND (etiology OR pathogenesis) AND (pediatrics)”.

RESULTS

A total of 32 articles were included. The etiology of growing pains still remains poorly understood. Many theories have been proposed, but none of them are decisive. A lower pain threshold has been found among patients suffering from growing pains in comparison to healthy controls. Furthermore, evidence suggests an association between growing pains and reduced bone strength in young patients, although this finding still remains controversial. Changes in the vascular perfusion pattern have also been studied. However, the etiology of growing pains does not seem related to a vascular component. The anatomical/mechanical theory has not been supported, but the role of vitamin D deficiency has been investigated many times. Strong recent evidence indicates a genetic susceptibility in the pathogenesis of growing pains. Furthermore, psychological factors also seem to play a strong role in the onset.

CONCLUSION

The scientific literature about the etiology of growing pains presents heterogeneity and lack of consensus; more studies are needed to understand the genesis of benign musculoskeletal pain syndrome of childhood.

Growing Pains

Context:

The term growing pains describes a common, benign syndrome of recurrent discomfort that occurs in young children. First described in the 1800s, the etiology of this condition remains unclear. The peak incidence does not correspond to a time of rapid growth. Children typically report bilateral pain in the lower extremities that occurs late in the day or at night.

Evidence Acquisition:

The PubMed database was searched using the keywords growing pains, benign nocturnal limb pains of childhood, recurrent limb pain of childhood, and limb pain in childhood. Articles were also found by reviewing references from the initial PubMed search. Only English-language articles published from 1900 through 2016 were included in the review.

Study Design:

Clinical review.

Level of Evidence:

Level 3.

Results:

When a patient’s history is classic for growing pains and physical examination is normal, laboratory and radiographic evaluation are not needed to make the diagnosis. Findings typical for growing pains include bilateral lower extremity pain usually experienced in the early evening or at night. The pain is not caused by activity and will not cause a limp.

Conclusion:

Additional workup is warranted for children with an atypical history, systemic symptoms, or for those individuals with physical examination abnormalities such as allodynia, focal tenderness, joint swelling, or decreased joint range of motion. Management of growing pains generally consists of symptomatic care with massage and over-the-counter analgesics, as well as reassurance to children and parents about the benign, self-limited nature of this condition. This review article summarizes data on the epidemiology, etiology, and management of growing pains and provides a framework for distinguishing this entity from other causes of extremity pain.

Restless Legs Syndrome/Willis-Ekbom Disease and Growing Pains in Children and Adolescents

Recent studies have shown that restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are common in pediatric population. The diagnostic criteria for Pediatric RLS have recently been updated to simplify and integrate with newly revised adult RLS criteria. Management of RLS and PLMD involves pharmacologic and nonpharmacologic interventions. Children with low iron storage are likely to benefit from iron therapy. Although, there is limited information on pharmacologic therapy, there are emerging literatures showing the effectiveness of dopaminergic medications in the management of RLS and PLMD in children. This article covers clinical evaluation of RLS and PLMD in children and the relationship with growing pains.

Effect of foot orthoses on children with lower extremity growing pains

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.

Growing pains: twin family study evidence for genetic susceptibility and a genetic relationship with restless legs syndrome

BACKGROUND

Growing pains (GP) is a prevalent familial childhood disorder of unknown aetiology. Familial occurrence of GP, and individual and familial association of GP with restless legs syndrome (RLS) has been reported.

METHODS

We applied a twin family design to search for evidence of genetic susceptibility to GP, and for a genetic relationship between GP and RLS. The parents of 1843 twin pairs aged 3-16 years were administered a questionnaire, which identified 88 pairs with at least one twin individual fulfilling criteria for GP. Standard questionnaires for history of GP and RLS were completed for these twin pairs, their siblings and parents.

RESULTS

Twenty-five of 34 monozygotic (MZ) pairs were concordant for GP, compared with 12 of the 54 dizygotic (DZ) pairs. The casewise concordance was 0.85 and 0.36 for MZ and DZ pairs, respectively (p < 0.001). The lifetime GP prevalence for relatives of twins with GP was 51% for non-twin siblings, 47% for parents. Twenty-three percent of twin individuals with GP met RLS criteria compared with 8% of twin individuals without GP (p = 0.03). Of the twins with GP concordance, 19% met RLS criteria compared with 2% of twins with GP discordance (p = 0.01). In two MZ pairs, one had GP and the other RLS. The lifetime prevalence of RLS was 40% for mothers, and 24% for fathers and 18% for non-twin siblings.

CONCLUSION

This first twin family study of GP provides evidence for a genetic aetiology and for a genetic relationship to RLS.

Somatosensory test responses in children with growing pains

PURPOSE

To further the understanding of growing pains (GP), in particular, the nature of this pain disorder.

METHODS

This study included 33 children aged 5-12 years who met criteria for GP (cases) and 29 children without GP of similar age and sex (controls). Nineteen controls were siblings of cases. GP was diagnosed by standard consensus questionnaires. A questionnaire addressed characteristics of the pain and family history of GP. Evidence for peripheral neuropathic disorder was tested by somatosensory testing and provocation tests of peripheral nerves. Somatosensory testing by a blinded researcher involved threshold determination and/or response magnitude to nonpainful stimuli including touch, dynamic brush, cold, vibration, and deep pressure applied to limb and abdominal sites.

RESULTS

Distributional, temporal, and quality characteristics of the pain were in accordance with published descriptions. There was no indication of primary musculoskeletal disorder. No evidence was found that GP is a peripheral neuropathic pain syndrome. There were minor but statistically significantly increased responses to cutaneous cold, vibration, and to deep pressure stimuli in cases compared to controls, evident in a wider distribution than the symptomatic lower limbs.

CONCLUSION

GP is a regional pain syndrome with evidence in this study of mild widespread disorder of somatosensory processing.

A medical record review for functional somatic symptoms in children

OBJECTIVE

The objectives of this study were to develop and test a systematic medical record review for functional somatic symptoms (FSSs) in paediatric patients and to estimate the inter-rater reliability of paediatricians' recognition of FSSs and their associated impairments while using this method.

METHODS

We developed the Medical Record Review for Functional Somatic Symptoms in Children (MRFC) for retrospective medical record review. Described symptoms were categorised as probably, definitely, or not FSSs. FSS-associated impairment was also determined. Three paediatricians performed the MRFC on the medical records of 54 children with a diagnosed, well-defined physical disease and 59 with 'symptom' diagnoses. The inter-rater reliabilities of the recognition and associated impairment of FSSs were tested on 20 of these records.

RESULTS

The MRFC allowed identification of subgroups of children with multisymptomatic FSSs, long-term FSSs, and/or impairing FSSs. The FSS inter-rater reliability was good (combined kappa=0.69) but only fair as far as associated impairment was concerned (combined kappa=0.29).

CONCLUSIONS

In the hands of skilled paediatricians, the MRFC is a reliable method for identifying paediatric patients with diverse types of FSSs for clinical research. However, additional information is needed for reliable judgement of impairment. The method may also prove useful in clinical practice.

Growing pains: a noninflammatory pain syndrome of early childhood

The term 'growing pains' has been used for almost 200 years to refer to the often severe, generally bilateral lower-extremity nocturnal pains experienced by up to one-third of all children at some time during early childhood. No clear mechanism has yet been identified that explains these pains, but there is an increasing body of evidence indicating that several factors, individually or in combination, might be responsible for this phenomenon. These include mechanical factors, such as joint hypermobility and flat feet, decreased pain thresholds, reduced bone strength, and emotional factors involving the patient's family and other social stressors. Correct diagnosis of growing pains requires a thorough patient history and physical examination. The diagnosis can be safely established without unnecessary laboratory investigations or imaging; however, identification of one or more clinical cautionary signs, such as unilateral pain, morning stiffness, joint swelling and systemic symptoms (e.g. fever, weight loss and malaise), should trigger an extended evaluation to exclude other more serious conditions that might also present with limb pain. Once the diagnosis has been established, conservative management, using symptomatic pain medications, massage and other supportive measures, should be employed until the syndrome self-resolves with time.

Growing pains: contemporary knowledge and recommended practice

Background

Leg pain in children, described as growing pains, is a frequent clinical presentation seen by an array of health care professionals. Described since 1823, growing pains continues to puzzle practitioners, yet diagnostic criteria and evidence based treatment is available.

Methods

The medical literature has been searched exhaustively to access all articles (English language) pertaining to leg pains in children which are ascribed to being 'growing pains'.

Results

The literature, whilst plentiful in quantity and spanning two centuries, is generally replete with reiterated opinion and anecdote and lacking in scientific rigour. The author searched 45 articles for relevance, determined according to title, abstract and full text, resulting in a yield of 22 original studies and 23 review articles. From the original studies, one small (non-blinded) randomised controlled trial that focused on GP treatment with leg muscle stretching was found. Nine prevalence studies were found revealing disparate estimates. Ten cohort (some case-controlled) studies, which investigated pain attribute differences in affected versus unaffected groups, were found. One series of single case experiment designs and one animal model study were found.

Conclusion

Growing pains is prevalent in young children, presents frequently in the health care setting where it is poorly managed and is continuing to be researched. A common childhood complaint, growing pains needs to be acknowledged and better managed in the contemporary medical setting.

Are laboratory tests necessary in making the diagnosis of limb pains typical for growing pains in children?

BACKGROUND

The present study was conducted to determine if performing laboratory tests are necessary to exclude other possible diagnoses in a child with limb pains typical for growing pains according to history and physical examination.

METHODS

A matched case-control study was carried out on children with limb pains who attended the Motahary clinic, Shiraz, Iran, in a 2 year period. The inclusion criteria were limb pains, which were recurrent and lasted for more than 3 months. The exclusion criteria were any abnormal systemic symptoms and signs, localizing signs, joint involvement; and limp or limitation of activity. The controls were clinically normal children matched for age and sex. Laboratory tests including complete blood count, erythrocyte sedimentation rate, serum calcium, phosphorus, alkaline phosphatase and rheumatoid factor were done for all patients and controls.

RESULTS

In total, 100 patients and 150 controls were included in the study. There were no significant differences between the patients and controls with regard to all of the measured laboratory tests.

CONCLUSION

Growing pain is a clinical diagnosis and if precise inclusion and exclusion criteria in history and physical examination are considered, there will be no need for laboratory tests in order to make a diagnosis.

Are foot posture and functional health different in children with growing pains?

BACKGROUND

The aim of the present paper was to investigate and compare findings of foot posture and functional health between groups of children aged 4-6 years with and without leg pain (described as "growing pains"). The null hypothesis: that there is no difference in measures of either foot posture or functional health between groups of children with and without leg pain.

METHODS

A stratified random sample of children was obtained. The children were identified with and without leg pain using a validated questionnaire for parents. The examiner was blind to the children's pain status. The schools and child care centers were from each geographical quadrant of metropolitan Adelaide and a northern rural region of South Australia. One hundred and eighty children (94 boys, 86 girls) entered and completed the study. Children whose parents returned a completed questionnaire and consent form were entered into the study. All participants were assessed by the one examiner. The foot posture measures used were those found to be most reliable in previous studies and for which the intra-rater reliability of the examiner was ascertained.

RESULTS

Initial analysis of foot posture measures between the leg pain and no leg pains groups indicated a statistically significant result for the measure of navicular height, but only on the left side (P = 0.033). Logistic regression modeling showed that navicular height (left foot only) was positively yet weakly related to growing pains (odds ratio, 1.072; 95% confidence interval: 0.991-1.160) and the effect was not significant (P = 0.08). Measures of functional health returned many statistically significant yet weakly correlated relationships.

CONCLUSIONS

The null hypothesis of the present study was supported in terms of clinical significance. While the foot posture measure of navicular height on the left foot was statistically significant it was not predictive for growing pains nor clinically significant as a measure between groups. The present study does not support the anatomical theory for growing pains and does not find a meaningful relationship between foot posture or functional health measures and leg pain in young children.

Can breastfeeding avert the appearance of growth pains during childhood?

Recurrent pains of the lower extremities (growth pains) constitute the most frequent cause of musculoskeletal pains in children. The disorder's pathophysiological mechanism remains unclear. Numerous researchers have tried to ascertain this by studying the anthropometrical characteristics of the children they examined, their family history and levels of physical activity, even their psychological background. To date though, no study has looked into whether breastfeeding may avert their appearance or limit their intensity and duration. Aiming to investigate the above theory, we conducted interviews with the mothers of 532 children, using a semiconstructed questionnaire. According to Petersen's criteria, 130 children presented growth pains during the last year. Specifically, 32.5% of non-breastfed children presented recurrent lower extremity pains, whereas such pains were identified in only 19.6% of breastfed children (p value = 0.001 < 0.005). The duration of breastfeeding also seems to play an important role. Indeed, amongst children breastfed for up to 40 days, the percentage of those presenting pain is 29.8%, whereas in those breastfed for more than 40 days, the respective percentage fell to 16.2% (p value = 0.001 < 0.005). These results show that there is a statistically significant dependence between the presentation of pains and whether the child had been breastfed or not, as well as the duration of breastfeeding during infancy. On the contrary, in children presenting growth pains, breastfeeding does not seem to affect the type or frequency of pain.

Growing pains in children

We review the clinical manifestations of "growing pains", the most common form of episodic childhood musculoskeletal pain. Physicians should be careful to adhere to clear clinical criteria as described in this review before diagnosing a child with growing pain. We expand on current theories on possible causes of growing pains and describe the management of these pains and the generally good outcome in nearly all children.

Risk factors for traumatic and non-traumatic lower limb pain among preadolescents: a population-based study of Finnish schoolchildren

BACKGROUND

The child's lower limb is the most commonly reported musculoskeletal location with pain and also the most commonly injured site in sports. Some potential risk factors have been studied, but the results are inconsistent. We hypothesized that distinction of traumatic from non-traumatic pain would provide a clearer picture of these factors. The aim of this study is to assess factors associated with lower extremity pain and its impact on preadolescents in a population-based cohort.

METHODS

A structured pain questionnaire was completed by 1756 schoolchildren of third and fifth grades to assess musculoskeletal pain, psychosomatic symptoms, subjective disabilities, school absence and frequency of exercise. In addition, hypermobility and physical fitness were measured.

RESULTS

The knee was the most common site of pain followed by the ankle-foot and thigh. Of the children who reported pain in their lower extremity, approximately 70% reported at least one disability and 19% reported school absence attributed to their pain during the previous three-month period. Children with traumatic pain had a higher subjective disability index than those with non-traumatic pain (P = 0.02). Age less than 11 years, headache, abdominal pain, depressive feelings, day tiredness, and vigorous exercise were more common in children with lower limb pain than those free of it. In the stratified analysis, younger age was related to both traumatic and non-traumatic pain groups. Vigorous exercise was positively associated with traumatic pain, while subjects with non-traumatic pain had more frequent psychosomatic symptoms.

CONCLUSION

Risk factors and consequences of traumatic and non-traumatic lower limb pain are not similar. Traumatic lower limb pain is associated with practicing vigorous exercise and high level of physical fitness, while non-traumatic pain is more correlated with psychosomatic symptoms. These differences might be one of the reasons for the discrepancy of previous research conclusions. The two conditions need to be treated as different disorders in future studies.

Prevalence of "growing pains" in young children

We estimated the prevalence of recurrent leg pains, often described as "growing pains" in children 4 to 6 years of age in South Australia. We used a survey of the parents of children 4 to 6 years of age, using a validated questionnaire previously developed for this purpose. The sample was systematic and randomized across rural and urban regions, with a total of 1445 valid responses achieved. Frequency statistics were used to obtain the prevalence estimate. The prevalence estimate obtained was 36.9% (95% CI, 32.7-41.1). This study estimated the prevalence of growing pains in a well-designed sample by using a validated instrument of measure. Previous studies have not addressed this age range discretely. The prevalence estimate demonstrates the community impact of this often disregarded condition.

Early pain in preterm infants. A model of long-term effects

There are multiple lines of evidence suggesting that in vulnerable prematurely born infants, repeated and prolonged pain exposure may affect the subsequent development of pain systems, as well as potentially contribute to alterations in long-term development and behavior. Multiple factors cumulatively contribute to altered developmental trajectories in such infants. These include characteristics of the developing organism (low tactile threshold, sensitization, rapid brain development), characteristics intrinsic to the infant (gestation, illness severity), characteristics of the experience in the neonatal intensive care unit (pain exposure and cumulative stress), and characteristics of the caregivers within their family and social context. This article provides a model for examining long-term effects of pain in the newborn period embedded in a developmental context framework.

Is there a subpopulation of children with growing pains who really have Restless Legs Syndrome? A review of the literature

Symptoms of Restless Legs Syndrome (RLS) can begin in childhood and persist into adulthood. To our knowledge, no one has done a systematic review of the literature to determine if the descriptions of 'growing pains' are consistent with the diagnosis of childhood RLS. Our group and that of Ekbom have noted that childhood onset RLS can be misdiagnosed as 'growing pains'. We therefore reviewed the work of seven groups of authors that addressed 'growing pains' as an isolated phenomenon in order to determine whether the descriptions of 'growing pains' were consistent with the clinical features of RLS. We found no consistent pattern in the descriptions even when articular pain was excluded. Thus, it is unlikely that all patients with 'growing pains' have RLS and it is likely that 'growing pains' is a heterogeneous disorder. The aforementioned authors were not looking for features unique to RLS and descriptions of the complete symptom complex of RLS are usually lacking. Further complicating the data are problems with methodology, e.g. in some studies small children and their parents were asked to retrospectively recall remote and infrequent events, and in other studies, articular pain was not adequately ruled out. Inconsistent with the hypothesis that RLS and 'growing pains' are the same are the high association of 'growing pains' with migraine headaches and abdominal pain. However, from this background emerge subsets of patients with 'growing pains' that are described as having one, some, or all of the following features consistent with the diagnosis of RLS: symptoms that are primarily in the legs, the patients rub their legs to get relief of the discomfort, the symptoms are worse at night, sleep disturbance is present and the discomfort is sometimes accompanied by motor restlessness A non-painful form of 'growing pains' has even been described. Ekbom and Brenning, a contemporary of Ekom, directly addressed the relationship between 'growing pains' and RLS. Ekbom felt that 'growing pains' and RLS were probably different since 'growing pains' disappear after childhood and one of his patients described her childhood 'growing pains' as being different from the sensory discomfort of her adult onset RLS. However, Brenning showed that RLS-like features in adulthood and a previous history of 'growing pains' in childhood occurred far more frequently in the parents of children with 'growing pains' than in control parents. More work needs to be done on the potential relationship between 'growing pains' and RLS.