It's a phrase I hear constantly: "Doctor, he has growing pains." Sometimes the parent says it, sometimes it comes as a label after a visit to the pediatrician or emergency room. The problem isn't that the expression is "forbidden"; the problem is that if we use it as a shortcut, we risk two opposite errors. On one hand, unnecessarily alarming families about a benign and frequent condition; on the other hand, dismissing as "growth" a pain that has incompatible characteristics and needs better assessment.
Recent literature has made an important point: there is no single shared definition of "growing pains," and studies use very different criteria, evaluations, and outcomes. [1] This explains why, in practice, we often find ourselves in a gray area: the same phrase is used to describe clinical situations that are not always overlapping.
What does this mean, in concrete terms, for a parent whose child complains of leg pain?
The "classic" picture that is usually benign
In daily life, the pains that most often fit a pattern compatible with "growing pains" have some recurring characteristics:
- they appear in the evening or at night, often after an active day;
- they affect both legs (not always, but often);
- they do not cause obvious swelling, redness, or warmth of the joint;
- in the morning, the child moves well again and does not limp.
A prospective study on preschool children in Denmark collected symptoms with a very "real-life" method (messages to parents every two weeks) and highlights precisely the need for clear criteria to avoid confusion with other diagnoses. [2] This is a useful message: if the picture is consistent and the child is well during the day, reassurance, observation, and some practical advice are often sufficient.
When the word "growth" is a red flag
Here I want to be clear. There are situations where leg pain should not be dismissed as "growing pains" without an evaluation:
- pain always in the same spot, especially if it is localized on a bone or joint;
- pain that progressively worsens or wakes the child every night;
- limping in the morning or difficulty walking during the day;
- swelling, redness, joint warmth;
- fever, weight loss, marked fatigue, or reduced appetite;
- pain after an injury that does not improve within a reasonable time;
- pain associated with weakness, tingling, or neurological changes.
These signs do not automatically mean something serious, but they are precisely the kind of elements that make a clinical assessment prudent: examination, possible blood tests or imaging, and scheduled follow-up.
A common misconception: "growing pains" and restless legs
The recent review published in BMJ Open highlights another aspect we often see: the literature mixes different categories of recurrent lower limb pain, including situations with characteristics overlapping with restless legs syndrome. [1] Translated: if the child describes discomfort in the legs with a need to move them, especially in the evening, and this disturbs sleep, the reasoning may be different from classic "post-activity" pain. It's worth mentioning to the pediatrician, because the approach changes.
What you can do at home, without over-medicalizing everything
If the picture is compatible with benign and intermittent pain:
- for 2–3 weeks, note when it appears (evening/night?), how long it lasts, if it's bilateral, and if the child is normal in the morning;
- during pain peaks, gentle massage and moderate warmth can help;
- if necessary, a pediatric analgesic according to the pediatrician's instructions (here the simple rule applies: do not improvise dosages).
If, on the other hand, there is one of the warning signs, it's better not to wait "for it to pass on its own": it is precisely in these cases that a timely evaluation avoids unnecessary detours later.
Disclaimer
This content is for informational purposes only and does not replace a medical visit. If your child has limping, persistent pain, swelling, fever, or progressive worsening, a clinical evaluation is prudent.
References
[1] Smith M, Pacey V, Davies LM, Coventry J, Ilhan E, Williams CM. Assessments, diagnostic criteria and outcome measures for growing pains and persistent pain in the presence of restless leg syndrome in children: a scoping review. BMJ Open. 2025;15(12):e101989. doi:10.1136/bmjopen-2025-101989.
PubMed: https://pubmed.ncbi.nlm.nih.gov/41338633/
[2] Hestbæk L, Lücking A, Jensen ST. Growing pains in Danish preschool children: a descriptive study. Sci Rep. 2024;14:3956. doi:10.1038/s41598-024-54570-3.
