Assessment

    Leg pain and “growing pains” in children

    Leg pain is common in childhood and is often called “growing pains”. Not every leg pain belongs to that picture, and telling them apart is part of the clinical assessment.

    Reviewed by the doctor: August 2026·Dr. Daniele Priano

    In brief

    The picture usually described as growing pains is intermittent, involves the lower limbs, tends to appear in the evening or at night and the child is generally well between episodes. Limping, pain that is persistent or always in the same spot, swelling, reduced movement or a child who gives up activities are less typical features and deserve a different clinical framing.

    How they usually present

    • • Pain that comes and goes, with symptom-free days or weeks in between
    • • Both legs are often involved, most commonly thighs, calves or behind the knees
    • • The pain is felt more in the evening or during the night than during the day
    • • The child usually plays, walks and runs normally between episodes
    • • There is no swelling, no redness and no obvious limitation of movement

    These are descriptive elements, not a checklist to reach a diagnosis at home: similar pictures can have different causes, and only a clinical assessment can tell them apart.

    Not all leg pain is the same

    In a growing child, leg pain can also come from load and sport, from a specific site of the knee or heel, or from the foot, knee or hip. Less frequently, the cause is not strictly orthopaedic. This is exactly why the label “growing pains” should not be applied automatically.

    There are also less common causes, including non-orthopaedic ones. They are not the first thing to think about, but they are one of the reasons why a pain that behaves in an unusual way deserves to be looked at rather than labelled.

    What makes the picture less typical

    • • Pain that persists rather than coming and going
    • • Pain always in the same spot, on one side only
    • • Pain also during the day, or that interrupts play and sport
    • • Limping, even intermittent
    • • Swelling, warmth or joint stiffness
    • • Reduced range of movement or difficulty bearing weight
    • • Fever or a child who is generally unwell

    None of these elements means a serious condition by itself. They simply make it inappropriate to attribute everything to “growing pains” without an assessment.

    “Growing pains is a label that reassures, and often it is appropriate. What I ask parents first is not where it hurts, but how the pain behaves: how often, at what time of day, whether it is always the same leg, whether the child stops doing something because of it. A pain that changes leg and disappears for weeks tells a very different story from one that has stayed in the same spot for a month.”

    — Dr. Daniele Priano

    What I assess during the visit

    • • The history of the pain: how long, how often, when during the day, which leg
    • • How the child walks and runs
    • • The lower limbs as a whole, comparing the two sides
    • • Hip, knee and ankle: movement and any painful areas
    • • Limb alignment and how the child loads the feet
    • • Whether any activity has been given up, and why

    Are investigations always needed?

    No. Investigations are not automatic: they are requested only when the history and the clinical examination suggest something specific to look for. In many cases the visit ends with a clearer explanation of the picture and no further tests at all.

    When an assessment can be useful

    • • Pain that persists or comes back frequently
    • • Pain always in the same place
    • • Pain during the day and not only in the evening
    • • Play or sport limited by the pain
    • • Limping, or a picture that does not look clearly typical

    Sometimes the visit simply confirms the reassuring features of the picture: that is a useful result too, because it avoids unnecessary investigations and repeated worry.

    Further reading

    A more detailed article discusses when this picture is genuinely reassuring and when it is not.

    “Growing pains”: when to worry→

    Leg pain that keeps coming back, or that does not look typical? A paediatric orthopaedic assessment can help clarify the picture.

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