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Growing Pains in Children

Discussion in 'Pediatrics' started by Ian North, Dec 7, 2004.

  1. Ian North

    Ian North Member


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    Recent Article in the Journal of Pediatric Orthopaedics.

    Growing Pains: Are They Due to Increased Growth During Recumbency as Documented in a Lamb Model?
    Noonan, Kenneth J. MD; Farnum, Cornelia E. DVM, PhD; Leiferman, Ellen M. DVM; Lampl, Michelle MD, PhD; Markel, Mark D. DVM, PhD; Wilsman, Norman J. DVM, PhD
    Journal of Pediatric Orthopedics. 24(6):726-731, November/December 2004.
    The authors suggest the growth plates are compressed during weightbearing.
    " A possible mechanism of pain may result from increased tension in the periosteum as the growth plates sping back from released compression or by some signal transduction mechanism during recumbency."

    With the successful use or orthoses and triplanar wedges in the reduction of symptoms associated with "growing pains", or lower leg aches are we seeing a mechanical affect on the bones/growth plates or simply reducing muscle fatigue ???

    Thoughts ???
     
    Last edited by a moderator: Dec 7, 2004
  2. Sean Millar

    Sean Millar Active Member

    Could it be that wedges and other biomechanical foot devices reduce periosteal tension/tugging, therefore reducing overall stress/inflammation experienced during periosteal growth phases. :confused:
     
  3. davidh

    davidh Podiatry Arena Veteran

    Bit of both, I would have thought :) .
    A search on "growing pains" will reveal several theories, only one of which is described in this article.
    Regards,
    David
     
  4. admin

    admin Administrator Staff Member

    Relationship Between "Growing Pains" and Foot Posture in Children Single-Case Experimental Designs in Clinical Practice
    Angela M. Evans
    Growing pains affecting one in three young children
    By Geraldine Hinter

     
  5. Ian North

    Ian North Member

    Theres no doubt that orthoses help symptoms of children with lower leg aches as demonstrated by A.Evans. We see this on a daily basis. The greatest effect of such devices is most likely on soft tissues and muscle function as opposed to recumbent leg growth as documented in the original article. It raises the old question "do growing bones hurt" ??? :rolleyes:
     
  6. admin

    admin Administrator Staff Member

    From the Australasian Podiatry Council Conference in Christchurch, NZ:

    Angela Evans
    Are Foot Posture and Functional Health Differrent in Children with Growing Pains?

    180 children; surveyed for growing pains and several health status measures.
    Several foot posture measures used (parts of FPI; navicular height and drop; etc).

    No clinical differences found in foot posture between those with growing pains and without.
     
    Last edited: Aug 31, 2005
  7. Kevin Kirby

    Kevin Kirby Well-Known Member

    Growing Pains in Children and Sports Injuries in Adults Share Common Etiologies

    Over the past decade, I have often stated that the podiatry and medical communities should be able to clearly see that children's "growing pains" are nothing more than a form of sports or athletic injury that we see commonly in adults. Children run and play most of the day. The normal running, jumping and playing activities that children perform on a daily basis, when combined with suboptimal structure and function of the foot and lower extremity, will lead to increased abnormal tissue stresses which will cause pain and injury.

    These athletic injuries, for some reason, have been called "growing pains" in children. However, if an adult goes out and runs, jumps and plays the same number of hours per day that a child does, develops similar aches and pains, we say they are "overdoing it" and have developed a "sports injury".

    From my perspective of seeing many children with "growing pains" and adults with "sports injuries" of the lower extremities for over 20 years, these two sets of injuries occur due to the same reasons. Therefore, children's growing pains should be treated just like sports injuries in adults: modified rest, ice, stretching, shoegear changes, over-the-counter orthoses and possibly custom foot orthoses.
     
  8. Kevin Kirby

    Kevin Kirby Well-Known Member

    I just went back over the Precision Intricast Newsletters I have done over the past few years and found that my August 2003 Newsletter was titled "Growing Pains in Children" where I discussed the research by many authors including Angela Evans' wonderful JAPMA paper from 2003.

    Here a few excerpts from the newsletter:

    And the last paragraph of the newsletter:

     
  9. One Foot In The Grave

    One Foot In The Grave Well-Known Member

    I'm in the process of putting my 4yo into some orthotics in the hope of reducing the number of times he complains of sore feet and legs (and to reduce the crying and sleeplessness that goes with it!)

    Just through observation (& not particularly vigilant obs at that!) I can equate the nights he waks up with sore legs to the days when he's been busiest. I've always assuemd it was "overuse" rather than growing pains.
     
  10. Kate Grundy

    Kate Grundy New Member

    Dear all experts
    Having treated children with "growing pains" for approx 20 years of my career I can say that in a large majority of children that complain consistently about "aching legs", reluctance to walk distances and asking to be carried because "my legs are tired", a functional biomechanical abnormality can be found. Most commonly an overpronated gait pattern. If this is successfully addressed then I become a miracle worker as far as the parent is concerned. The child stops complaining and waking at night and not wanting to walk. This is I accept not backed up by a research project done by me but on my clinical expereince. I think it would be an interesting Masters study if I can ever pluck up the energy to do one. In the meantime I will continue to treat these children in the same way as it gets the results the parent (and I hope the child) wants.
    I accept as Mr Kirby states that some of these pains may be as a result of overuse as a child who runs around a lot may be very alike the pains an athelete gets when training but a lot of the chilren that I see arn't running around because of the pans that they get and because the legs are tired as a result of the compenatory nature of the gait patterns they are exhibiting. Once this is controlled then they can run around more withou the pain. I am doing a presentation on this very subject to colleagues so would value any information/ researchthat I could use to support this. I think the pain levels vary from child to child just as pain levels vary from adult to adult depending on their individual pain thesholds so it is difficult to quantify whether the "crying with pain" child is actually in more pain than the child who is just complaining. it is good to know that research is going on in these areas.
    Kate Grundy
    Podiatrist NHS UK
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    “Growing pains” in young children: A study of the profile, experiences and quality of life issues of four to six year old children with recurrent leg pain
    The Foot Volume 16, Issue 3 , September 2006, Pages 120-124
     
  12. NewsBot

    NewsBot The Admin that posts the news.

    Todays British Medical Journal has this editorial:
    Growing Pains (only those with institutional access can get the full article
     
  13. Freeman

    Freeman Well-Known Member

    For those nay-sayers who doubts mechanical stress is a factor, ask how many kids have growing pains in their arms, hands, etc. If they grow at the same rate as feet and legs, why do not children have growing pains there? I have had similar very good results with children over many years who I have treated as being biomechanically greater at risk or developing overuse stress injuries.

    Last note: orthodonic dentristry seems to approach alignment with an early intervention attitude to prevent teeth, jaws from taking on an injurious attitude.
    Best regards
    Freeman Churchill, Certified Pedorthist (Canada)
     
  14. yvonnespod

    yvonnespod Member

    As a mother and pod ,whatever order you please, my 6years old has experience "Growing pains" -unilaterally in his left calf -occasionally for approx 3 years and only after a busy day and going to bed later than usual Panadol helped
    Can growing pains be unilateral? yvonnespod
     
  15. carol

    carol Well-Known Member

    unnilateral growing pains

    As another mother and Pod, please get your 6 year old with unilateral pains checked for Juvenile Arthritis, my Daughter suffered for 3 years before she was correctly diagnosed, she only has it in one knee but we were told for ages she had growing pains/ cartilage problems/ attention seeking etc etc
    :) Don't panic though, they do grow out of it, my daughter is now 15 and hasn't had a flare for 6 months. And yes, orthotics help a lot, damage limita tion is imperative to prevent problems later on.
     
  16. Podiatry777

    Podiatry777 Well-Known Member

    Re: Unilateral Growing Pains

    Dear Mum/Pods,

    Have you done a biomechanical assessment rulling out scoliosis,hip drop, leg length discrepancy? Orthotics work well wiith these patients if the biomechanical difference in R and L is not excessive. Have son 9 who developed aches early, and loves to run. Wears soft full length orthotics.

    Pod777
     
  17. Hylton Menz

    Hylton Menz Guest

    Re: Growing Pains

    Tuesday, April 24, 2007. 6:45am (AEST)

    Sydney researchers begin study into 'growing pains'

    Researchers at a Sydney hospital are investigating the cause of growing pains in children, but it appears the cause is unlikely to have anything to do with growing.

    Nocturnal limb pain syndrome, or growing pains, is a common childhood complaint.

    The syndrome affects many children aged between three and 13, with pain usually felt in the legs during the night.

    Associate Professor David Champion of the Sydney Children's Hospital says there have been many theories about the causes, including growth, flat fleet and bone fatigue, but none have been proven.

    He says it is likely to be caused by something similar to that of severe headaches.

    "Migraine is clearly a disordered function of the nervous system and so it appears likely that growing pains syndrome is disordered function in nervous system," he said.

    He says the hospital is looking for child volunteers to be part of the research that involves non-invasive tests and the findings will be released later this year.

    He says he hopes the study will shed some light on the problem (more from the ABC...)
     
  18. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Re: Growing Pains

    :confused: :confused:

    Migraine's??

    Huh?!?

    The dear professor seems to have grabbed two utterley different pathologies and brought them together from out of nowhere.

    Is my education at fault - or does this seem like a complete load of nonsense - whatever current 'growing pains' theory you subscribe to!

    Someone please enlighten me. :eek:

    LL
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    Re: Growing Pains

    Are foot posture and functional health different in children with growing pains?
    ANGELA MARGARET EVANS, SHEILA DOREEN SCUTTER
    Pediatrics International (OnlineEarly Articles).
    doi:10.1111/j.1442-200X.2007.02493.x
     
  20. JFAR

    JFAR Well-Known Member

    Re: Growing Pains

    Growing pains: contemporary knowledge and recommended practice

    Angela M Evans

    Journal of Foot and Ankle Research 2008, 1:4doi:10.1186/1757-1146-1-4

    Published: 28 July 2008

    Abstract (provisional)

    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.

    Conclusions
    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.
     
  21. NewsBot

    NewsBot The Admin that posts the news.

    Press Release:
    Study is the first to link sleep duration to infant growth spurts

     
  22. NewsBot

    NewsBot The Admin that posts the news.

  23. NewsBot

    NewsBot The Admin that posts the news.

    Growing Pains: A Study of 30 Cases and a Review of the Literature
    Pavone, Vito, Lionetti, Elena, Gargano, Valerio, Evola, Francesco R., Costarella, Luciano, Sessa, Giuseppe
    Journal of Pediatric Orthopaedics: July/August 2011 - Volume 31 - Issue 5 - p 606–609
     
  24. Robertisaacs

    Robertisaacs Well-Known Member

    What Kevin said.

    Funny thing about growing pains is that they are (in my experience) probably the easiest fix with orthoses. If they are "growing pains" why should that be?

    And why are they never in elbows?
     
  25. Kevin Kirby

    Kevin Kirby Well-Known Member

    Robert:

    I agree. I can't remember the last case of "growing pains" I didn't cure with custom foot orthoses. Funny, the children continued growing even with the orthoses.:rolleyes:
     
  26. NewsBot

    NewsBot The Admin that posts the news.

    Bone strength in children with growing pains: long-term follow-up
    Y. Uziel, G. Chapnick, A. Oren-Ziv, L. Jaber, D. Nemet, P. Hashkes
    Pediatric Rheumatology (in press)
     
  27. C Johnston

    C Johnston New Member

    Couple of question folks put in the simplest of terms. Is it the growth of bone that causes the pain or the struggle of ligaments, tendons and muscles to 'catch up'. If the latter is the case, surely a stretching regieme may be more beneficial that othoses. If, in most cases, there is overpronation, could that not just be caused by 'tight' tendons. Just a thought.
     
  28. NewsBot

    NewsBot The Admin that posts the news.

     
    Last edited by a moderator: Sep 22, 2016 at 7:58 AM
  29. Craig Payne

    Craig Payne Moderator

    One of our students posted this in our internal learning forum. I have their permission to repost it here.
    A timely reminder on the seriousness that "growing pains" needs to be given.
     
  30. CraigT

    CraigT Well-Known Member

    I believe the rule is that as soon as a paeds patient reports this, they need an Xray...
    Was the poorly isolated pain unilateral or bilateral??
     
  31. NewsBot

    NewsBot The Admin that posts the news.

    The Daily Telegraph are reporting:
    'Our little girl's "growing pains" were actually cancer': Parents' anguish as daughter, 9, nearly loses leg to deadly bone tumour

    Full story
     
  32. NewsBot

    NewsBot The Admin that posts the news.

    Here is another:
    Highwood family’s ordeal met with community support
     
  33. NewsBot

    NewsBot The Admin that posts the news.

  34. NewsBot

    NewsBot The Admin that posts the news.

  35. NewsBot

    NewsBot The Admin that posts the news.

    Agony of schoolgirl's 'growing pains' turns out to be rare form of arthritis

     
  36. NewsBot

    NewsBot The Admin that posts the news.

    A Growing Pains (gp) Questionnaire : Validation And Reliability Control
    M Vasilopoulou, E Kritseli, N Myriokefalitakis, M Tsolia
    Arch Dis Child 2014;99:A238
    Growing pains: twin family study evidence for genetic susceptibility and a genetic relationship with restless legs syndrome.
    Champion D, Pathirana S, Flynn C, Taylor A, Hopper JL, Berkovic SF, Jaaniste T, Qiu W.
    Eur J Pain. 2012 Oct;16(9):1224-31.
     
    Last edited: Feb 20, 2015
  37. NewsBot

    NewsBot The Admin that posts the news.

    A New Growing Pains Diagnostic Tool:evaluation In A Mediterranean Clinical Sample
    M Vassilopoulou, A Spathis, I Paspati, M Tsolia
    Arch Dis Child 2014;99:A567-A568
     
  38. Admin2

    Admin2 Administrator Staff Member

  39. drhunt1

    drhunt1 Well-Known Member

    The differential diagnosis, and the methods by which, not only the pain presents itself, but by the physician's techniques, is critical. For instance, while myelogenous leukemia, neuroblastomas, rhabdomyosarcoma and osteosarcomas are real concerns, for the most part, they present differently than true GPs.

    Rhabdomyosarcoma:

    http://www.cancer.org/cancer/rhabdomyosarcoma/detailedguide/rhabdomyosarcoma-signs-symptoms

    osteosarcoma:

    http://kidshealth.org/parent/medical/cancer/cancer_osteosarcoma.html

    myelogenous leukemia:

    http://www.cancer.gov/cancertopics/pdq/treatment/childAML/Patient/page1

    neuroblasomas:

    http://kidshealth.org/parent/medical/cancer/neuroblastoma.html#

    The key and common finding, if these cancers do present in the LE, is swelling in the limb with pain upon palpation to the swelling. In GPs, there is no swelling or pinpoint pain elicited with palpation to the lower or upper leg. While blood tests and plain film radiographs can be utilized to R/O these rare cancers, (as well as Still's Ds), there is no positive findings from these tests with GPs.

    Dr. Hight and myself have made the hypothesis that the majority of GPs is referred from the STJ.

    http://www.podiatrym.com/Current_Issue2.cfm?id=1632

    Considering the percentages of children that present with pain in their legs at night, we stand by that hypothesis. The only pain that is elicited by the practitioner, is palpation to the sinus tarsi, or posterior facet of the STJ, usually much worse in the afternoon, which resolves after orthotic therapy after the 2nd night of treatment. Much more research needs to be performed on the tie between GPs and RLS, but the authors feel this was a necessary start to the discussion.
     
  40. NewsBot

    NewsBot The Admin that posts the news.

    Perinatal Risk Factors and Genu Valgum Conduce to the Onset of "Growing Pains" in Early Childhood.
    Kaspiris, A.; Chronopoulos, E.; Vasiliadis, E.
    Preprints 2016, 2016080113 (doi: 10.20944/preprints201608.0113.v1).
     
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