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Growing pains

Last updated: July 11, 2025

Summarytoggle arrow icon

Growing pains are a common, benign, and self-limited noninflammatory musculoskeletal pain syndrome that affects children. The cause remains unknown. Although growing pains have no standardized definition or diagnostic criteria, they are typically characterized by bilateral nonarticular pain in the lower extremities that occurs late in the day or during the night. Pain is absent during the daytime and when active. Growing pains are a clinical diagnosis. Individuals with atypical symptoms, abnormal examination findings, and/or features of systemic illness should receive a diagnostic evaluation to exclude alternative diagnoses (e.g., overuse syndromes, anatomical abnormalities, infections, neoplasms). Management is supportive and consists of massage, heat therapy, and nonopioid oral analgesics. Most cases resolve spontaneously by adolescence.

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Etiologytoggle arrow icon

  • Unknown [1][2]
  • No proven correlation with periods of rapid growth [1]
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Epidemiologytoggle arrow icon

  • Prevalence estimates vary. [2]
  • Most commonly occurs between 3 and 12 years of age [1]

Epidemiological data refers to the US, unless otherwise specified.

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Clinical featurestoggle arrow icon

Clinical features of growing pains

Pain is the defining feature of growing pains and is typically characterized by the following: [1][3]

  • Intensity: mild to severe
  • Location [3]
    • Bilateral [1]
    • Most commonly affects the lower extremities (e.g., shins, calves, thighs, popliteal fossae)
    • Nonarticular
  • Timing
    • Episodic (lasts minutes to hours) [4]
    • Occurs in the evening or nighttime and may:
      • Manifest after increased physical exertion
      • Awaken the child from sleep, but resolve by morning
    • Absent during the day or when active

Pain that limits activity should raise suspicion for differential diagnoses of growing pain. [1]

Red flag features of growing pains [1][2]

Any of the following clinical features suggests a differential diagnosis of growing pains.

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Diagnosistoggle arrow icon

Approach [1][2]

Growing pains are a clinical diagnosis. [1][2]

Laboratory and/or imaging are used to evaluate for suspected alternative causes. [1][2]

Diagnostic studies [1][2]

Laboratory and imaging studies are normal in children with growing pains. Based on clinical suspicion, obtain diagnostic studies to exclude alternative causes. [1][2]

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Managementtoggle arrow icon

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