"Growing pains" describes a common condition of intermittent limb pain, especially in the evening or at night, in children who are otherwise well between episodes. The definition, however, is less uniform than the name suggests.
A scoping review published in Pediatrics analyzed 145 studies and found highly variable diagnostic criteria. Only about half mentioned lower limb pain, less than half required evening or nighttime onset, and barely a third required a normal clinical examination. 93% of the studies made no reference to growth. [1]
They don't seem to depend on growth velocity
For a long time, it was taken for granted that these pains occurred because bones grow rapidly. This is intuitive, but the available data do not confirm it.
In 2024, a Danish group followed 777 children, collecting information on musculoskeletal pain every two weeks. Depending on the criteria used, between 24% and 43% of children presented with a picture consistent with growing pains. When the authors compared painful episodes with growth velocity, they found no association: children who grew faster did not experience more pain than others. [2]
A meta-analysis published in 2026, which compiled 37 studies and over 16,000 children, reached the same conclusion: among the many factors studied, rapid growth did not emerge as an associated factor. [3]
For this reason, I continue to use the term "growing pains," because it is the one everyone knows, but I consider it primarily a historical name. It does not mean that bones hurt because they are lengthening.
So what is the typical picture?
More than a single characteristic, the combination of elements matters.
Typical pain is intermittent: there are days or periods completely free of pain. It appears mainly towards evening or during the night, and in the morning, the child returns to their normal activities. It primarily affects the lower limbs, often the calves, shins, thighs, or the area around the knees, without any true swollen or painful joint.
In the Danish study, pain occurred most often one to three times a week, and about 80% of episodes affected both legs. One in four children also experienced sleep disturbance, while in most cases, there were no consequences during the day. [2]
Bilateral pain is therefore reassuring, but I would not turn it into an absolute rule. In the same study, about 20% of compatible episodes were unilateral. A single episode in one leg can therefore still fall within a benign picture; different is pain that always returns to the same spot, especially if it progressively becomes more intense.
A particularly useful element is how the child is between episodes. If in the morning they run, walk, climb stairs, and do not limp, the picture is more consistent with recurrent benign pain. Functional limitation that persists during the day, however, requires a different assessment.
Why do they occur? The most accurate answer is: we don't know yet
Over the years, many explanations have been proposed: increased physical activity, muscle fatigue, joint hypermobility, the way the foot bears weight, lower bone density, lower pain threshold, family factors, and even psychological components.
The 2026 meta-analysis finds some interesting associations. In children with growing pains, high physical activity and joint hypermobility are more frequent; overall, physical activity was associated with the condition with an odds ratio of about 1.34. A lower average pain threshold, a certain familial predisposition, and small differences in bone density parameters have also been described. [3]
These are useful data, but they must be interpreted correctly. An association does not mean that hypermobility "causes" growing pains, nor that an active child should reduce sports to prevent them. There might simply be a group of children who are more sensitive to the musculoskeletal stimuli of the day.
In practice, parents often report more frequent episodes after particularly intense days. This is plausible and consistent with some data, but we have not yet demonstrated a single mechanism.
What about vitamin D?
This is probably the topic on which the most confusion has arisen in recent years.
Several older studies had found very low vitamin D levels in a large percentage of children with growing pains. In some cohorts, pain decreased after supplementation, and from this, the idea arose that vitamin D deficiency could be a cause. [4]
The problem is that many of these studies did not have a true control group. If vitamin D deficiency is common even in children without pain, finding many low values in the "growing pains" group does not demonstrate a cause-and-effect relationship.
A case-control study published between 2025 and 2026 is particularly instructive: 95.6% of children with growing pains had insufficient or deficient vitamin D, but the percentage in healthy controls was practically identical, 93.3%. Furthermore, pain improved over time even in children with sufficient levels who had not received supplementation. [5]
The 2026 meta-analysis continues to find, overall, lower average vitamin D levels in children with growing pains, but the authors themselves emphasize the heterogeneity of the studies. [3]
Vitamin D should be evaluated and corrected when there is a clinical indication. The available data do not justify automatic testing and supplementation in all children with this type of pain.
There is also another condition that can resemble it
An interesting aspect that has emerged in recent years is the overlap with restless legs syndrome.
In a family study of twins, about a third of subjects who met the traditional criteria for growing pains also presented characteristics compatible with a painful form of restless legs. [6] The most useful distinguishing factor is the need to move the legs: the child describes an unpleasant sensation when still, feels the need to move, and movement provides relief.
This is not the same as a child who wakes up with calf pain and wants to be massaged. It's an important nuance, especially when episodes significantly disturb sleep or there is a family history of restless legs.
A 2025 scoping review confirms that in the literature, the two conditions have often been poorly distinguished and that more uniform diagnostic criteria are needed. [7]
When pain does not fit the usual pattern of growing pains
The fact that pain appears at night, by itself, is not a warning sign: nocturnal pain is part of the classic description. It becomes less reassuring when the rest of the picture changes.
Pain that deserves a more careful evaluation:
- is persistent or progressively increases over weeks;
- always returns to the same spot, especially on a bone or joint;
- is still present in the morning or is accompanied by stiffness;
- causes limping, limits play, or makes the child give up sports;
- is associated with swelling, redness, warmth, or reduced movement of a joint;
- appears along with fever, unusual fatigue, weight loss, or other general symptoms;
- is associated with weakness, altered sensation, or other neurological symptoms.
These are very different situations, and in the majority of cases, they do not hide a serious pathology. The reason it is important to recognize them is that in these children, it is not advisable to simply stop at the label "they are growing."
Are X-rays or blood tests needed?
In a child with a very typical history and a normal clinical examination, tests are not automatically necessary. This is one of the points on which the literature is quite consistent. [8]
But it is also why, in less clear cases, clinical assessment comes before tests. It doesn't make much sense to request a series of analyses or X-rays "just in case" without knowing what you are looking for. The medical history and physical examination, however, allow us to understand whether we are truly dealing with a benign pattern or if there is an element that warrants targeted investigation.
The evaluation does not necessarily serve to find a disease or prescribe a therapy. In many children, it serves precisely to confirm that the pain has reassuring characteristics and to avoid unnecessary checks. In others, however, it allows us to realize that the pain does not truly fit the classic picture and needs to be studied differently.
What can be done when the picture is typical
The treatment for growing pains is much less sophisticated than one might think, also because there are few good quality studies.
Massage, local heat, and reassurance are the most commonly used measures. If the pain is significant, a common pediatric analgesic may be helpful, with dosage and indication agreed upon with the pediatrician. I see no reason to systematically suspend sports if the child is completely asymptomatic during the day and does not limp.
Stretching is often recommended. There is a small, now historical, randomized study of 34 children that observed a faster resolution of symptoms in the group that performed muscle stretching. [9] This is interesting data, but too small and old to turn stretching into a mandatory therapy for everyone.
For the same reason, I would not automatically prescribe physiotherapy, orthotics, supplements, or other treatments solely based on the label "growing pains." If, during the visit, muscle tightness, marked hypermobility, functional alterations, or other specific elements emerge, then the indications can be personalized.
What to observe at home
The most reassuring picture is that of a child with intermittent episodes, especially in the evening or at night, who walks and plays normally between episodes.
Persistent pain, always localized in the same spot, associated with limping, limitation during the day, or other clinical signs, however, warrants a different evaluation. The term "growing pains" should not be used to automatically explain any recurrent leg pain.
References
[1] O’Keeffe M, et al. Defining Growing Pains: A Scoping Review. Pediatrics. 2022;150(2):e2021052578. doi:10.1542/peds.2021-052578.
[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.
[3] Luo T, Huang Y, Guo Y, Lian X. Risk factors associated with growth pain disorder in children: a systematic review and meta-analysis. Front Pediatr. 2026;14:1806380. doi:10.3389/fped.2026.1806380.
[4] Vehapoglu A, Turel O, Turkmen S, et al. Are Growing Pains Related to Vitamin D Deficiency? Efficacy of Vitamin D Therapy for Resolution of Symptoms. Med Princ Pract. 2015;24(4):332-338. doi:10.1159/000431035.
[5] Jain I, K A, Agarwal N, Nayak S, Jindal A. Does Vitamin D Deficiency Contribute to Growing Pains? A Case-Control Study. Clin Pediatr (Phila). 2026;65(2):196-202. doi:10.1177/00099228251379209.
[6] Champion GD, Bui M, Sarraf S, et al. Improved definition of growing pains: A common familial primary pain disorder of early childhood. Paediatr Neonatal Pain. 2022;4(2):78-86. doi:10.1002/pne2.12079.
[7] 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.
[8] Lehman PJ, Carl RL. Growing Pains. Sports Health. 2017;9(2):132-138. doi:10.1177/1941738117692533.
[9] Baxter MP, Dulberg C. “Growing pains” in childhood—a proposal for treatment. J Pediatr Orthop. 1988;8(4):402-406. doi:10.1097/01241398-198807000-00004.
