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Hestbæk L, Lücking A, Jensen ST. Growing pains in Danish preschool children: a descriptive study. Sci Rep 2024; 14:3956. [PMID: 38368453 PMCID: PMC10874442 DOI: 10.1038/s41598-024-54570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/14/2024] [Indexed: 02/19/2024] Open
Abstract
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.
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Affiliation(s)
- Lise Hestbæk
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Chiropractic Knowledge Hub, Odense, Denmark.
| | | | - Sarah Thurøe Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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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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Liao CY, Wang LC, Lee JH, Wu KW, Lin YT, Yang YH, Chiang BL, Yu HH. Clinical, laboratory characteristics and growth outcomes of children with growing pains. Sci Rep 2022; 12:14835. [PMID: 36050454 PMCID: PMC9436948 DOI: 10.1038/s41598-022-19285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/26/2022] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Chung-Yuan Liao
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.,Department of Pediatrics, Taitung Hospital, Ministry of Health and Welfare, Taitung, Taiwan
| | - Li-Chieh Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jyh-Hong Lee
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Kuan-Wen Wu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.,Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Tsan Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.,Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Hui Yu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
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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; 150:188581. [PMID: 35864176 DOI: 10.1542/peds.2021-052578] [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: 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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Overlapping features of restless legs syndrome and growing pains in Turkish children and adolescents. Brain Dev 2022; 44:372-379. [PMID: 35221168 DOI: 10.1016/j.braindev.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/01/2022] [Accepted: 02/13/2022] [Indexed: 11/21/2022]
Abstract
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.
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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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Abstract
BACKGROUND Leg pain is a common reason for consultation in the children's orthopedic clinic. It can occur across all age groups, although most patients are of pre-school or elementary school age. As there are a series of possibly severe differential diagnoses that might cause such pains in children and adolescents apart from benign pains that occur in the context of growth, a thorough patient history and physical examination are essential. PATHOGENESIS Despite extensive research, the cause of benign growing pains has not been elucidated so far. Several possible factors play a role on an anatomical, metabolic or functional basis, ; thus, various theories exist with regard to their origin. DIAGNOSIS Growing pains constitute a diagnosis of exclusion. If a possible organic cause of the pains is suspected, an extended diagnosis of the person affected should be made. Growing pains primarily occur at night and are always self-resolving. THERAPY With regard to treatment, mild pain medications can be employed in more severely affected patients. It is much more important to inform family members about the benign nature of the condition. Reassuring words and physical relaxation exercises, in addition to massaging and stretching of the leg muscles, can cause a significant reduction in pain without medication.
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Affiliation(s)
- S Adolf
- Orthopädische Universitätsklinik Friedrichsheim, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland.
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Pavone V, Vescio A, Valenti F, Sapienza M, Sessa G, Testa G. Growing pains: What do we know about etiology? A systematic review. World J Orthop 2019; 10:192-205. [PMID: 31041161 PMCID: PMC6475815 DOI: 10.5312/wjo.v10.i4.192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/15/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Fabiana Valenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
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Correlates and predictors of paediatric leg pain: a case-control study. Rheumatol Int 2018; 38:1251-1258. [PMID: 29797060 DOI: 10.1007/s00296-018-4056-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/16/2018] [Indexed: 01/15/2023]
Abstract
Paediatric leg pains, long described as 'growing pains', frequently present to clinicians, are prevalent in early childhood, disrupt sleep, and distress affected children and parents. There are many cited associations, but no defined leg pain sub-types, nor revealed predictive factors. We explored the implicated factors (viz. foot arches, foot strength, joint mobility, vitamin D, iron) in children with leg pain versus a control group. Leg pain sub-groups-growing pains (GP), restless legs (RLS), both (mixed)-are defined for the first time. A case controlled study design, in a primary care setting, Mumbai, India. A total of 77 children with leg pains (n = 64) and controls (n = 13), aged 3-12 years, identified by paediatricians, completed data collection. Blood assays for iron and vitamin D, pain, Beighton score, foot arch, foot strength and anthropometrical data were collected. All outcome measures were validated, with standardised protocols. Leg pain (all groups) was predicted by increased joint mobility and increased ankle dorsiflexion strength (β = 0.56, P < 0.05). GP sub-group was predicted by increased ankle dorsiflexion strength (β = - 0.06, P < 0.05). Mixed (GP/RLS) and RLS sub-groups were predicted by increased ankle dorsiflexion strength (β = 0.66, P < 0.05) and pain questionnaire (β = 0.11, P < 0.05). Hypovitaminosis D was detected in 87% of the sample, and anaemia in 13%. Increased strength of ankle dorsiflexors and joint flexibility were each found predictive for leg pain. Increased body weight, waist girth, and BMI were all associated with leg pain.
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Approach to Growing Pains in Childhood in a Familial Mediterranean Fever Endemic Region. IRANIAN JOURNAL OF PEDIATRICS 2017. [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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Abstract
Limping in children is a common complaint at pediatric, pediatric orthopaedic offices and in emergency rooms. There are several causes for this condition, and identifying them is a challenge. The older the patient, the better the anamnesis and more detailed the physical examination will be, enabling an easier medical assessment for searching the source of the disorder. In order to make the approach easier, three age groups can and should be considered. Among infants (1 to 3 years old), diagnosis will most likely be: transitory synovitis, septic arthritis, neurological disorders (mild brain palsy (BP) and muscular dystrophy), congenital hip dislocation (CHD), varus thigh, juvenile rheumatoid arthritis (JRA) and neoplasias (osteoid osteoma, leukemia); in the scholar age group, between 4 and 10 years old, in addition to the diagnoses above, Legg-Calvé-Perthes disease, discoid meniscus, inferior limbs discrepancy and unspecific muscular pain; in adolescents (11 to 15 years old): slipped capital femoral epiphysis, congenital hip dislocation, chondrolysis, overuse syndromes, dissecans osteochondritis, and tarsal coalition. The purpose of this study is to provide an update on how to approach pediatric patients presenting with limping, and to discuss its potential causes.
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Affiliation(s)
- Cláudio Santili
- Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas, Santa Casa de Sao Paulo; Assistant Physician, Pediatric Orthopedics and Traumatology Group, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
- Correspondence: Dr. Cláudio Santili, Departamento de Ortopedia e Traumatologia da Santa Casa de São Paulo-Grupo de Ortopedia e Traumatologia Pediátrica, Rua Cesário Mota Junior, 112-01277-900-São Paulo, SPCorrespondence: Dr. Cláudio SantiliDepartamento de Ortopedia e Traumatologia da Santa Casa de São Paulo-Grupo de Ortopedia e Traumatologia PediátricaRua Cesário Mota Junior112-01277-900-São Paulo, SP.
| | - Wilson Lino Júnior
- Pediatric Orthopedics and Traumatology Group, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - Ellen de Oliveira Goiano
- Interning Physician, Pediatric Orthopedics and Traumatology Group, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - Romero Antunes Barreto Lins
- Resident (R3) Physician, Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas, Santa Casa de Sao Paulo, Sao Paulo, Brazil
| | - Gilberto Waisberg
- Pediatric Orthopedics and Traumatology Group, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - Susana dos Reis Braga
- Master in Orthopedics, Faculdade de Ciências Médicas, Santa Casa de Sao Paulo; Physician, Pediatric Orthopedics and Traumatology Group, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Miguel Akkari
- Head, Pediatric Orthopedics and Traumatology Group, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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Spencer CH, Patwardhan A. Pediatric Rheumatology for the Primary Care Clinicians-Recognizing Patterns of Disease. Curr Probl Pediatr Adolesc Health Care 2015. [PMID: 26205101 DOI: 10.1016/j.cppeds.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This review presents a diagnostic approach to musculoskeletal and rheumatic diseases in children for primary care clinicians. The focus is on juvenile idiopathic arthritis (JIA) as the major arthritis disease in children. It is necessary to know the personalities of these JIA categories. It is also crucial to be able to recognize the common infectious, orthopedic and mechanical, malignant, genetic, other rheumatic diseases, and other miscellaneous syndromes that can mimic JIA. To do so requires recognition of clinical patterns using a thorough musculoskeletal and rheumatic history and repeated complete physical exams with emphasis on the musculoskeletal exam. It also requires targeted and limited laboratory testing with careful follow-up over time.
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Abstract
Joint pains are a common reason for children to present to primary care. The differential diagnosis is large including some diseases that do not primarily affect the musculoskeletal system. Although the cause for many patients will be benign and self-resolving, in rare cases the diagnosis is associated with long-term morbidity and mortality if not detected early and appropriately treated. These include primary and secondary malignancies, septic arthritis, osteomyelitis, inflammatory arthritis, slipped upper femoral epiphysis (SUFE) and non-accidental injury. We highlight the importance of a thorough history and directed yet comprehensive examination. A diagnostic algorithm is provided to direct primary care physicians' clinical assessment and investigation with the evidence base where available. In many cases, tests are not required, but if there is suspicion of malignancy, infection or inflammatory conditions, laboratory tests including full blood count, blood film, erythrocyte sedimentation rate, C-reactive protein and lactate dehydrogenase help to support or exclude the diagnosis. Autoimmune tests, such as antinuclear antibodies and rheumatoid factor, have no diagnostic role in juvenile idiopathic arthritis; therefore, we advise against any form of 'rheumatological/autoimmune disease screen' in primary care. Imaging does have a place in the diagnosis of joint pains in children, with plain radiographs being most appropriate for suspected fractures and SUFE, whilst ultrasound is better for the detection of inflammatory or infective effusions. The appropriate referral of children to paediatric rheumatologists, oncologists, orthopaedic surgeons and the emergency department are discussed.
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Affiliation(s)
- E S Sen
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | - S L N Clarke
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK.
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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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Vehapoglu A, Turel O, Turkmen S, Inal BB, Aksoy T, Ozgurhan G, Ersoy M. Are Growing Pains Related to Vitamin D Deficiency? Efficacy of Vitamin D Therapy for Resolution of Symptoms. Med Princ Pract 2015; 24:332-8. [PMID: 26022378 PMCID: PMC5588252 DOI: 10.1159/000431035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/30/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the 25-hydroxyvitamin D [25(OH)D] status of children with growing pains and to evaluate the efficacy of vitamin D treatment on the resolution of pain symptoms. SUBJECTS AND METHODS One hundred and twenty children with growing pains were included in a prospective cohort study. Serum 25(OH)D and bone mineral levels were measured in all subjects at the time of enrollment. The pain intensity of those with vitamin D deficiency was measured using a pain visual analog scale (VAS). After a single oral dose of vitamin D, the pain intensity was remeasured by means of the VAS at 3 months. The 25(OH)D levels and VAS scores before and after oral vitamin D administration were compared by means of a paired Student's t test. RESULTS In the 120 children with growing pains, vitamin D insufficiency was noted in 104 (86.6%). Following vitamin D supplementation, the mean 25(OH)D levels increased from 13.4 ± 7.2 to 44.5 ± 16.4 ng/ml, the mean pain VAS score decreased from 6.8 ± 1.9 to 2.9 ± 2.5 cm (a mean reduction of -3.8 ± 2.1, p < 0.001) and the difference was statistically significant. CONCLUSION Supplementation with oral vitamin D resulted in a significant reduction in pain intensity among these children with growing pains who had hypovitaminosis D.
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Affiliation(s)
- Aysel Vehapoglu
- Department of Pediatrics, Bezmialem Vakıf University School of Medicine, Istanbul, Turkey
- *Aysel Vehapoglu, Department of Pediatrics, Bezmialem Vak�f University, School of Medicine, Vatan Street, Fatih, TR–34093 Istanbul (Turkey), E-Mail
| | - Ozden Turel
- Department of Pediatrics, Bezmialem Vakıf University School of Medicine, Istanbul, Turkey
| | - Serdar Turkmen
- Department of Biochemistry, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Berrin Belcik Inal
- Department of Biochemistry, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Turgut Aksoy
- Department of Biochemistry, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Gamze Ozgurhan
- Department of Pediatrics, Suleymaniye Obstetrics and Gynecology Hospital, Istanbul, Turkey
| | - Murat Ersoy
- Department of Biochemistry, Istanbul Training and Research Hospital, Istanbul, Turkey
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Wong MW, Williamson BD, Qiu W, Champion D, Teng A. Growing pains and periodic limb movements of sleep in children. J Paediatr Child Health 2014; 50:455-60. [PMID: 24547979 DOI: 10.1111/jpc.12493] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether there was any association between growing pains (GP) and periodic limb movements of sleep (PLMS) in children referred for polysomnography (PSG), in light of the possible shared genetic determinants between GP and restless legs syndrome. METHODS Records of all 903 children who underwent PSG at a paediatric hospital between January 2009 and May 2010 were retrospectively reviewed. Children aged 3-16 years, without neuromuscular or neurological/developmental disorders who were seen by a single sleep physician were included in the analysis. Data extracted included: current GP, PLMS index, mixed obstructive apnoea/hypopnoea index and patient demographics. GP was diagnosed in the pre-PSG consultation. RESULTS GP was recorded in 43 of the eligible 230 children referred for PSG of whom 25.6% had a PLMS index ≥ 5/h, significantly higher than in the children without GP (10.2%) (odds ratio 3.04, χ(2) = 6.0, P = 0.014). The adjusted odds ratio for the association between GP and PLMS remained significant at 2.53 (95% CI 1.1-6.1, P < 0.05). A PLMS index ≥ 5/h was recorded in 30 of the 230 participants. GP and PLMS were also significantly multivariately associated with restlessness as the indication for PSG. CONCLUSIONS Children with GP were three times more likely to have a PLMS index ≥ 5/h than children without GP on PSG. These results suggest that GP may be associated with PLMS, giving greater support for the hypothesis that GP might lie on the phenotypic spectrum of restless legs syndrome.
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Affiliation(s)
- Man Wai Wong
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Acute and non-acute lower extremity pain in the pediatric population: part II. J Pediatr Health Care 2012; 26:216-30. [PMID: 22526001 DOI: 10.1016/j.pedhc.2012.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 01/27/2012] [Accepted: 01/30/2012] [Indexed: 11/21/2022]
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Pathirana S, Champion D, Jaaniste T, Yee A, Chapman C. Somatosensory test responses in children with growing pains. J Pain Res 2011; 4:393-400. [PMID: 22247622 PMCID: PMC3255993 DOI: 10.2147/jpr.s24875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Shanthi Pathirana
- Department of Anesthesia and Pain Medicine, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - David Champion
- Department of Anesthesia and Pain Medicine, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- Department of Rheumatology, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - Tiina Jaaniste
- Department of Anesthesia and Pain Medicine, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - Anthony Yee
- Department of Rheumatology, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - Cindy Chapman
- Department of Anesthesia and Pain Medicine, Sydney Children’s Hospital, Randwick, New South Wales, Australia
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Kaspiris A, Zafiropoulou C. Growing pains in children: Epidemiological analysis in a Mediterranean population. Joint Bone Spine 2009; 76:486-90. [DOI: 10.1016/j.jbspin.2009.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 02/02/2009] [Indexed: 11/28/2022]
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Growing pains: a noninflammatory pain syndrome of early childhood. ACTA ACUST UNITED AC 2008; 4:542-9. [PMID: 18762787 DOI: 10.1038/ncprheum0903] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 07/28/2008] [Indexed: 01/15/2023]
Abstract
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.
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Evans AM. Growing pains: contemporary knowledge and recommended practice. J Foot Ankle Res 2008; 1:4. [PMID: 18822152 PMCID: PMC2553776 DOI: 10.1186/1757-1146-1-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 07/28/2008] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Angela M Evans
- School of Health Science, Division of Health Science, University of South Australia, City East Campus, North Terrace, Adelaide, 5000, Australia.
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