Diagnosis of Growing Pains
The diagnosis of Growing Pains is based largely on clinical history and physical examination, as there are no specific tests or imaging studies that confirm the condition. Instead, the diagnosis of Growing Pains is made by excluding other causes of limb pain in children and identifying the classic pattern of symptoms associated with this benign condition.
Most children who present with recurrent leg pain but appear otherwise healthy are likely to be diagnosed with Growing Pains. The process is guided by parental reporting, medical history, physical examination, and a careful search for any red flags that could indicate more serious pathology.
Clinical History
The diagnosis begins with a detailed account of the child’s symptoms, including:
Timing of the pain (e.g. evenings or night-time)
Location (typically both legs, often in the calves or thighs)
Duration and frequency of episodes
Whether the child is pain-free during the day
Any association with physical activity
Presence or absence of systemic symptoms (fever, fatigue, weight loss)
Clinicians often ask about:
The child’s energy levels and daily functioning
Any change in behaviour, mobility, or sleep patterns
Past illnesses, recent infections, or injuries
A history consistent with Growing Pains supports the diagnosis when combined with normal findings on physical examination.
Physical Examination
A thorough physical assessment includes:
Inspection of the legs and joints for swelling, redness, or deformity
Palpation to check for tenderness or localised pain
Assessment of gait and mobility
Examination of posture, foot arches, and leg alignment
Children with Growing Pains will:
Have no joint abnormalities
Walk and play normally during the day
Experience relief with massage or stretching
Appear well between episodes
These findings help rule out conditions like arthritis, fractures, or bone tumours.
No Diagnostic Tests Required
In typical cases, no blood tests or imaging are necessary. However, investigations may be ordered if:
The pain is unilateral or persistent
There is visible swelling or inflammation
The child experiences pain during the day
There are constitutional symptoms (fever, weight loss, night sweats)
The child is younger than 2 years or older than 12 years
Tests that may be used to rule out other conditions include:
X-rays, if bone injury or tumour is suspected
Blood tests, such as full blood count, inflammatory markers, or vitamin D levels
MRI scans, in rare cases, to examine bone marrow or soft tissues
Differential Diagnosis
The diagnosis of Growing Pains must be distinguished from:
| Condition | Key Differentiating Features |
| Juvenile Idiopathic Arthritis | Persistent joint pain, stiffness, swelling, morning symptoms |
| Bone tumours | Localised pain, swelling, worsening at night, weight loss |
| Leukaemia | Bone pain, fatigue, bruising, fever |
| Osteomyelitis or septic arthritis | Fever, limp, joint swelling, severe pain |
| Rickets | Bone deformities, muscle weakness, delayed growth |
If any of these are suspected, immediate referral to a paediatric specialist is warranted.
Red Flag Symptoms
Clinicians are trained to watch for:
Unilateral pain
Daytime limp or restricted mobility
Swollen joints
Fever or signs of infection
Neurological symptoms
Pain that worsens over time
The absence of these signs strongly supports a diagnosis of Growing Pains.
Role of Parental Reassurance
The diagnosis is greatly aided by open communication with parents. Many are anxious that their child’s pain could be linked to something serious. Providing clear, empathetic explanations helps:
Validate the child’s experience
Reassure caregivers that the condition is self-limiting
Reduce unnecessary anxiety, investigations, or referrals
Doctors may offer advice on pain management strategies, such as warm baths, massage, and gentle stretching exercises, which are often more helpful than medications.
When to Refer to a Specialist
Referral to a paediatric rheumatologist or orthopaedic surgeon may be necessary if:
Symptoms are atypical
The child is not responding to conservative care
Diagnostic uncertainty remains after examination and history
There is concern about bone or joint pathology
In most cases, however, reassurance and conservative care are sufficient.
Conclusion | Diagnosis of Growing Pains
The diagnosis of Growing Pains is clinical and relies on recognising a characteristic pattern of symptoms in an otherwise healthy child. By carefully ruling out other causes of limb pain and providing reassurance to families, healthcare professionals can confidently support children through this common phase of development. Understanding how to make an accurate diagnosis of Growing Pains reduces unnecessary testing, promotes comfort-based care, and allows children to continue thriving.
