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Stories for Reprint
When Is Pain More Than Just Growing Pains?
By Katerina Pesheva
Your pre-teen son wakes up in the middle of the night grabbing his legs, complaining of terrible pain. At the doctor's office the next day, your physician suggests the episode was a bout of growing pains. But what if the incident is a harbinger of something more ominous, such as juvenile arthritis, a condition affecting some 285,000 children in the United States?
Diagnosing growing pains vs. a more serious rheumatic condition should be fairly easy.
"The two conditions look quite different to any physician that's worth anything," says Dr. Andy White, assistant professor of pediatrics at the Washington University School of Medicine in St. Louis and director of the school's Division of Pediatric Rheumatology and Immunology.
Growing pains usually occur between the ages of 4 and 12, equally in boys and girls. Some studies have shown that as many as one in five school-age children (20 percent) experience growing pains. Misdiagnosing juvenile arthritis as growing pains is perhaps fairly rare, White says, but the reverse is a fairly common occurrence.
"What happens more often is the other way around-children being diagnosed with juvenile arthritis when all they have is growing pains," White says. One reason might be that "growing pains" is fairly vague label and hyper-vigilant doctors and concerned parents sometimes err on the side of a more specific diagnosis.
In fact, some pediatricians do not believe growing pains is a standalone medical condition at all, but rather a misnomer that has been applied all too often to other conditions, White explains.
"It's unclear whether growing pains even exists," White says. "Growth doesn't really hurt. It's probably other conditions that cause it."
One condition that might be often mislabeled as "growing pains" is benign hyper-mobility syndrome, a condition marked by extra flexible joints that might cause pain in a growing child.
The diagnostic label should be of little concern, as long as a child has normal physical exam and normal blood tests, White says.
Here are several telltale signs that parents might find helpful in differentiating between juvenile arthritis and more benign conditions.
Growing pains DO:
Cause deep aching and cramping pain in the thigh, shin or calf
Occur at night, often waking up the child, and are never present in the morning, which distinguishes them from rheumatic conditions, where the pain is more severe in the morning or constant throughout the day
Are usually precipitated by exercise the previous day
Growing pains DO NOT:
Cause limping
Cause pain in the lower back or groin area
Respond to massage or common pain-relievers
Cause stiffness, swelling and redness of the joints. These are symptoms usually attributed to juvenile rheumatoid arthritis
To rule out rheumatic conditions, the physician should perform a thorough medical history, physical examination and consider appropriate laboratory studies.
For more information on juvenile arthritis, go to the following Web sites:
www.marrtc.org/conditions/juvenile.html(Missouri Arthritis Rehabilitation Research and Training Center)
www.arthritis.org/conditions/diseasecenter/typesofja.asp(Arthritis Foundation)
www.rheumatology.org/public/factsheets/jra.asp(American College of Rheumatology)
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