4 August 2022

Growing pains is ‘not a diagnosis’

Pain Pharmaceuticals

It’s a common diagnosis for unexplained pain in children, but a review of the literature has found that definitions of “growing pains” are contradictory, variable, vague and lacking in clarity. 

However, the researchers said children and adolescents do commonly experience pain without a clear clinical explanation, and need help with pain management.

Up to a third of children were diagnosed with growing pains at some stage, the review by University of Sydney researchers found.

“That’s an enormous number of children,” said Professor Steven Kamper, senior author and Professor of Allied Health at the University of Sydney & Nepean Blue Mountains Local Health District.

The review published in Pediatrics found that there was no agreement about where growing pains were located, how old children were when it began, or how long the pain continued.

“That raised the question of why there isn’t a coherent diagnosis,” Professor Kamper said.

“It’s a term that’s been around for a long time and it’s used quite broadly, but once you scratch below the surface, it’s a mystery as to what it really means.”

More than 93% of the studies did not refer to growth when defining the condition and 80% did not mention the age of participants.

“Of the 100-odd studies that we included in our review, only a very small handful actually mentioned growth at all when we looked at how growing pains was defined,” Professor Kamper said.

The researchers were surprised by the findings because the term growing pains was “what’s on the box”, he said.

“I think it’s a diagnosis of exclusion when we can’t find anything else, and a catch-all term for pain for which we cannot find any particular origin or reason.”

Professor Kamper said there was no good evidence that growth in itself caused pain.

“We’re not suggesting that children aren’t having a painful experience. But from a research and clinical perspective, we don’t appear to have a handle on what’s going on for a large number of kids who report pain.

“If medical professionals want to use the term growing pains, then it should come with a coherent definition because it currently means different things to different people.”

It may be more helpful to acknowledge that children feel pain even if there was no clinical explanation, he said.

“From a clinical perspective, we may be better off saying: ‘I believe you have pain, but we don’t really know what’s going on’.

“From what we understand about pain, that validation is really important for adults and equally so for children.”

Professor Kamper said children who experienced chronic pain were more likely to become adults with chronic pain.

“It’s important to understand what’s going on for children who are experiencing pain. Everyone experiences pain and it’s a normal part of life, but it’s the pain which really impacts and persists that we need to be concerned about.”

“Growing pains” was often used as a catch-all term when a child’s muscle or joint symptoms didn’t fit with another diagnosis, said Dr Joshua Pate, Lecturer in Physiotherapy at the University of Technology, Sydney.

“However, growing pains could potentially encapsulate many different conditions, and lumping these all into one category could be an unhelpful over-simplification.”

Dr Pate said if children had persisting pain, it was important to be assessed by a health professional to rule out any potential sinister pathologies, without dismissing or over-medicalising a child’s experience of pain.

“It’s an important study and it sets the stage for more paediatric pain research,” said Dr Pate, who researches the way children understand pain.

“The way that people think about pain can sometimes be very concrete and potentially too narrow. But research has shown that many things influence our experiences of pain, such as our environment, understanding, thoughts, feelings, past experiences and expectations.”

Pediatrics 2022, online 22 July