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Zhang W, Xu X, Leng H, Shen Q, Lu Q, Zheng X. An exploration of clinical features and factors associated with pain frequency and pain intensity in children with growing pains: a cross-sectional study from Chongqing, China. Pain Rep 2024; 9:e1164. [PMID: 38835745 PMCID: PMC11146583 DOI: 10.1097/pr9.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/09/2024] [Accepted: 03/24/2024] [Indexed: 06/06/2024] Open
Abstract
Instruction Growing pains are the most common cause of musculoskeletal pain in children, affecting both children's and caregivers' well-being. The lack of definitive diagnostic criteria complicates diagnosis and treatment. Objectives This study aims to outline the clinical features and identify factors associated with the frequency and intensity of growing pains in children in Chongqing, China. Methods A cross-sectional study was conducted in a children's hospital using its Internet hospital follow-up platform. Children initially diagnosed with growing pains between July and September 2022 were enrolled. Sociodemographics, pain locations, duration, frequency, intensity, and potentially related factors were collected. Results Eight hundred sixty-three children were enrolled (average age: 8.19 ± 3.24 years; 455 boys [52.72%]). Pain frequency was reported as quarterly (62.11%), monthly (24.80%), biweekly (1.74%), weekly (10.08%), and daily (1.27%). The prevalence of mild, moderate, and severe pain was 26.65%, 55.74%, and 17.61%, respectively. The knee was the most common pain location (63.85%), mostly encountered between 4 pm and 5 pm (20.51%). Multivariate analysis revealed that pain frequency negatively correlated with vitamin supplementation during pregnancy, positively correlated with underweight, bad temper, increased exercise, and cold lower extremities. Pain intensity positively correlated with irritability, increased exercise, and pain sensitivity but negatively correlated with age and vitamin supplementation during lactation. Conclusion Growing pains typically occur on a quarterly basis, predominantly affecting the knees during 4 pm to 5 pm. Factors in sociodemographics, maternal aspect, temperament, and exercise levels can influence pain frequency and intensity. Clinicians should consider these aspects when developing comprehensive strategies for pain management.
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Affiliation(s)
- Wenni Zhang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
- Department of Endocrinology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ximing Xu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
- Big Data Center for Children's Medical Care, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hongyao Leng
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qiao Shen
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qiufan Lu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xianlan Zheng
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
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Hestbæk L, Lücking A, Jensen ST. Growing pains in Danish preschool children: a descriptive study. Sci Rep 2024; 14:3956. [PMID: 38368453 PMCID: PMC10874442 DOI: 10.1038/s41598-024-54570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/14/2024] [Indexed: 02/19/2024] Open
Abstract
This study provides a detailed description of growing pains in young Danish children as standardized diagnostic criteria are needed to avoid misclassifications of other musculoskeletal diagnoses. The study is nested in a cohort study of Danish preschool children. At baseline, parents completed a questionnaire with sociodemographic information. During the study, the parents received a text message every two weeks inquiring about musculoskeletal pain in the child. If pain was reported, a telephone interview about pain characteristics was conducted. The present study includes data from 2016 to 2019 with 777 children, aged 3-6 years of age at baseline. The prevalence of growing pains was 24-43%, depending on the definition. The pain occurred most frequently 1-3 times per week and most commonly in the lower legs, could be unilateral or bilateral and was usually without consequences. The prevalence increased with age, and there were no consistent associations with socio-economic factors. We suggest using Evan's criteria with the addition of unilateral pain as standard diagnostic criteria in the future. We found no relation to periods of rapid growth and suggest that the term is a misnomer. Etiology and long-term courses of pain need to be explored in future studies.
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Affiliation(s)
- Lise Hestbæk
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Chiropractic Knowledge Hub, Odense, Denmark.
| | | | - Sarah Thurøe Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Silva-Néto RP, Soares ADA, Souza WPDO, Krymchantowski AG, Jevoux C, Krymchantowski A. "Growing pains" in children and adolescents as an early symptom of migraine: A prospective study. Headache 2023; 63:1070-1075. [PMID: 37671464 DOI: 10.1111/head.14608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Children and adolescents may experience pain in the lower limbs, predominantly at the end of the day or during the night, without any relation to organic disease. These pains are often called "growing pains" (GP) by pediatricians and orthopedists. They are commonly attributed to rapid growth. OBJECTIVE The aim of this study was to review and characterize GP in children and adolescents as a precursor/comorbidity with migraine. METHODS The study was of a cross-sectional, prospective, longitudinal cohort, with group comparison. A sample of 100 children/adolescents born to mothers with migraine seen at a headache clinic was recruited in a random order chosen by lot, maintaining the ratio of 1:1 for the group with GP and the controls. Both groups were followed for a period of 5 years. RESULTS After 5 years of follow-up, 78 patients completed the study, of which 42 were from the GP group and 36 were from the control group. Headache fulfilling the International Classification of Headache Disorders, 3rd edition diagnostic criteria for migraine without aura or probable migraine occurred in 32/42 (76%) of patients with GP and in 8/36 (22%) of controls (p < 0.001). In the sample that initially had "growing pains," these pains persisted in 6/42 (14%) and appeared in 14/36 (39%) of those who were previously asymptomatic (p = 0.026). CONCLUSIONS Pain in the lower limbs of children and adolescents, commonly referred to as GP by pediatricians and orthopedists, may reflect a precursor or comorbidity with migraine.
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Affiliation(s)
| | | | | | | | - Carla Jevoux
- Headache, Headache Center of Rio, Rio de Janeiro, Brazil
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4
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Dijkstra JN, Boon E, Kruijt N, Brusse E, Ramdas S, Jungbluth H, van Engelen BGM, Walters J, Voermans NC. Muscle cramps and contractures: causes and treatment. Pract Neurol 2023; 23:23-34. [PMID: 36522175 DOI: 10.1136/pn-2022-003574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 12/23/2022]
Abstract
Muscle cramps are painful, sudden, involuntary muscle contractions that are generally self-limiting. They are often part of the spectrum of normal human physiology and can be associated with a wide range of acquired and inherited causes. Cramps are only infrequently due to progressive systemic or neuromuscular diseases. Contractures can mimic cramps and are defined as shortenings of the muscle resulting in an inability of the muscle to relax normally, and are generally myogenic. General practitioners and neurologists frequently encounter patients with muscle cramps but more rarely those with contractures. The main questions for clinicians are: (1) Is this a muscle cramp, a contracture or a mimic? (2) Are the cramps exercise induced, idiopathic or symptomatic? (3) What is/are the presumed cause(s) of symptomatic muscle cramps or contractures? (4) What should be the diagnostic approach? and (5) How should we advise and treat patients with muscle cramps or contractures? We consider these questions and present a practical approach to muscle cramps and contractures, including their causes, pathophysiology and treatment options.
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Affiliation(s)
- Jildou N Dijkstra
- Department of Neurology, Radboud Universiteit, Nijmegen, The Netherlands
| | - Eline Boon
- Department of Neurology, Radboud Universiteit, Nijmegen, The Netherlands
| | - Nick Kruijt
- Department of Neurology, Radboud Universiteit, Nijmegen, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Sithara Ramdas
- MDUK Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK.,Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Heinz Jungbluth
- Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's and St Thomas' Hospitals NHS Trust, London, UK.,Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, UK
| | | | - Jon Walters
- Department of Neurology, Morriston Hospital, Swansea, UK
| | - Nicol C Voermans
- Department of Neurology, Radboud Universiteit, Nijmegen, The Netherlands
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5
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Liao CY, Wang LC, Lee JH, Wu KW, Lin YT, Yang YH, Chiang BL, Yu HH. Clinical, laboratory characteristics and growth outcomes of children with growing pains. Sci Rep 2022; 12:14835. [PMID: 36050454 PMCID: PMC9436948 DOI: 10.1038/s41598-022-19285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/26/2022] [Indexed: 11/09/2022] Open
Abstract
Growing pains (GP), a common and benign pain syndrome of unknown etiology, is characterized by bilateral recurrent leg pain in childhood. There are no standardized diagnostic criteria for GP, and the diagnosis is often made by exclusion. To identify clinical and laboratory features, we included patients < 12 years with GP at National Taiwan University Children's Hospital between April 2006 and April 2019 in a retrospective study. We also compared body weight and body height z-scores between diagnosis and up to 2 years post-diagnosis to determine if rapid growth was associated with GP. This cohort study included 268 patients with a mean age of 4.7 ± 2.2 years. The most common features of GP were bilateral leg pain, no limitation of activity, intermittent pain, normal physical examination, and being well physically. The average number of Walters' criteria fulfilled by the patients with GP was 6.7 ± 0.9. Elevated serum levels of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were observed in 37.5% and 15.6% of patients, respectively. Symptomatic medications were used in 33% of patients. Our study indicates that ALP and LDH may be biomarkers associated with GP. There was no significant association between GP and rapid growth within 2 years of diagnosis.
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Affiliation(s)
- Chung-Yuan Liao
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.,Department of Pediatrics, Taitung Hospital, Ministry of Health and Welfare, Taitung, Taiwan
| | - Li-Chieh Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jyh-Hong Lee
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Kuan-Wen Wu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.,Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Tsan Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.,Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Hui Yu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
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6
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O'Keeffe M, Kamper SJ, Montgomery L, Williams A, Martiniuk A, Lucas B, Dario AB, Rathleff MS, Hestbaek L, Williams CM. Defining Growing Pains: A Scoping Review. Pediatrics 2022; 150:e2021052578. [PMID: 35864176 DOI: 10.1542/peds.2021-052578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Up to one third of children may be diagnosed with growing pains, but considerable uncertainty surrounds how to make this diagnosis. The objective of this study was to detail the definitions of growing pains in the medical literature. METHODS Scoping review with 8 electronic databases and 6 diagnostic classification systems searched from their inception to January 2021. The study selection included peer-reviewed articles or theses referring to "growing pain(s)" or "growth pain(s)" in relation to children or adolescents. Data extraction was performed independently by 2 reviewers. RESULTS We included 145 studies and 2 diagnostic systems (ICD-10 and SNOMED). Definition characteristics were grouped into 8 categories: pain location, age of onset, pain pattern, pain trajectory, pain types and risk factors, relationship to activity, severity and functional impact, and physical examination and investigations. There was extremely poor consensus between studies as to the basis for a diagnosis of growing pains. The most consistent component was lower limb pain, which was mentioned in 50% of sources. Pain in the evening or night (48%), episodic or recurrent course (42%), normal physical assessment (35%), and bilateral pain (31%) were the only other components to be mentioned in more than 30% of articles. Notably, more than 80% of studies made no reference to age of onset in their definition, and 93% did not refer to growth. Limitations of this study are that the included studies were not specifically designed to define growing pains. CONCLUSIONS There is no clarity in the medical research literature regarding what defines growing pain. Clinicians should be wary of relying on the diagnosis to direct treatment decisions.
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Affiliation(s)
- Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Steven J Kamper
- Centre for Pain, Health and Lifestyle, New South Wales, Australia
- School of Health Sciences
- Nepean Blue Mountains Local Health District, Penrith, Australia
| | - Laura Montgomery
- Institute for Musculoskeletal Health, Sydney Local Health District and The University of Sydney, Sydney, Australia
| | - Amanda Williams
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales, Australia
| | - Alexandra Martiniuk
- School of Public Health, Faculty of Medicine, and Health
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
- Dalla Lana School of Public Health, The University of Toronto, Ontario, Canada
| | - Barbara Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School
- John Walsh Center for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Physiotherapy Department, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | | | - Michael S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, Clinical Biomechanics, University of Southern Denmark, Campus vej 55, 5230, Odense, Denmark
- The Chiropractic Knowledge Hub, Odense, Denmark
| | - Christopher M Williams
- Centre for Pain, Health and Lifestyle, New South Wales, Australia
- Hunter New England Population Health Unit, Newcastle, Australia
- University of Newcastle, Callaghan, Australia
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Overlapping features of restless legs syndrome and growing pains in Turkish children and adolescents. Brain Dev 2022; 44:372-379. [PMID: 35221168 DOI: 10.1016/j.braindev.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/01/2022] [Accepted: 02/13/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Restless legs syndrome (RLS) and growing pains (GPs) share many common features and are sometimes overlapping diagnoses. The present study aims to investigate the shared features of patients with RLS, classified based on the 2013 diagnostic criteria of International Restless Legs Syndrome Study group and of patients with GPs, diagnosed based on the combined criteria proposed in 2013. METHODS A cross-sectional population study was conducted in 7 Istanbul schools, which were selected randomly. A total of 4565 (56.1% female) children aged 9 to 18 years were included. In the first stage, candidates of RLS and GPs were identified based on 2 separate questionnaires, whose diagnoses were confirmed by a second survey applied to them under parental supervision. RESULTS Out of 192 children (65.6% female) diagnosed as definite RLS (yearly prevalence: 4.2%), 30 (15.6%) reported bilateral leg muscle pain localized typical regions for GPs, which started <13 years of age in 17 children. An urge to move the legs to relieve unpleasant sensations or pain was present in 39.3% of 140 children (64.3% female) classified as GPs (yearly prevalence: 3.1%). Occurrence of symptoms at rest or when lying down was present in 36.4% of GPs children and relief by gross movements was in 21.4% children. Only 12 patients (9 with definite RLS and 3 with GPs) (0.03% of total cohort) were eligible for overlapping diagnosis of GPs and RLS. CONCLUSION Although a considerable number of patients with RLS and GPs share some clinical features, a combined phenotype is very rare.
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Abstract
BACKGROUND Leg pain is a common reason for consultation in the children's orthopedic clinic. It can occur across all age groups, although most patients are of pre-school or elementary school age. As there are a series of possibly severe differential diagnoses that might cause such pains in children and adolescents apart from benign pains that occur in the context of growth, a thorough patient history and physical examination are essential. PATHOGENESIS Despite extensive research, the cause of benign growing pains has not been elucidated so far. Several possible factors play a role on an anatomical, metabolic or functional basis, ; thus, various theories exist with regard to their origin. DIAGNOSIS Growing pains constitute a diagnosis of exclusion. If a possible organic cause of the pains is suspected, an extended diagnosis of the person affected should be made. Growing pains primarily occur at night and are always self-resolving. THERAPY With regard to treatment, mild pain medications can be employed in more severely affected patients. It is much more important to inform family members about the benign nature of the condition. Reassuring words and physical relaxation exercises, in addition to massaging and stretching of the leg muscles, can cause a significant reduction in pain without medication.
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Affiliation(s)
- S Adolf
- Orthopädische Universitätsklinik Friedrichsheim, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland.
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Pavone V, Vescio A, Valenti F, Sapienza M, Sessa G, Testa G. Growing pains: What do we know about etiology? A systematic review. World J Orthop 2019; 10:192-205. [PMID: 31041161 PMCID: PMC6475815 DOI: 10.5312/wjo.v10.i4.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/15/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Growing pains is the most common cause of musculoskeletal pain in early childhood and was first described in 1823 by French physician Marcel Duchamp. Although it has been researched extensively, the etiology is still unknown. Several theories have been proposed throughout the years. AIM Analyze the available scientific literature to provide an update on the latest evidence on the etiology. METHODS According to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the scientific literature on the etiology of growing pains was systematically reviewed using the following inclusion criteria: studies of any level of evidence reporting clinical or preclinical results and dealing with the etiology of growing pains. The medical electronic databases PubMed and Web of Science were searched by two independent authors on October 20, 2018. The search string used was "(growing pains OR benign nocturnal limb pains OR musculoskeletal pains) AND (etiology OR pathogenesis) AND (pediatrics)". RESULTS A total of 32 articles were included. The etiology of growing pains still remains poorly understood. Many theories have been proposed, but none of them are decisive. A lower pain threshold has been found among patients suffering from growing pains in comparison to healthy controls. Furthermore, evidence suggests an association between growing pains and reduced bone strength in young patients, although this finding still remains controversial. Changes in the vascular perfusion pattern have also been studied. However, the etiology of growing pains does not seem related to a vascular component. The anatomical/mechanical theory has not been supported, but the role of vitamin D deficiency has been investigated many times. Strong recent evidence indicates a genetic susceptibility in the pathogenesis of growing pains. Furthermore, psychological factors also seem to play a strong role in the onset. CONCLUSION The scientific literature about the etiology of growing pains presents heterogeneity and lack of consensus; more studies are needed to understand the genesis of benign musculoskeletal pain syndrome of childhood.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Fabiana Valenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania 95123, Italy
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Abstract
This article focuses on creating an orderly approach to history taking, examination, and ordering appropriate investigations when caring for a child with joint complaints. It classifies complaints as those with and without pain, swelling, or fever and of short or long duration. It recommends an approach to the physical examination and both suggests and discourages various laboratory and imaging studies.
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Affiliation(s)
- Kathleen A Haines
- Pediatric Immunology, Section of Pediatric Rheumatology and Immunology, Department of Pediatrics, Seton Hall-Hackensack Meridian School of Medicine, Hackensack University Medical Center, 30 Prospect Avenue, Room WFAN 360, Hackensack, NJ 07601, USA.
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11
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Beyitler I, Kavukcu S. Approach to Growing Pains in Childhood in a Familial Mediterranean Fever Endemic Region. IRANIAN JOURNAL OF PEDIATRICS 2017; 27. [DOI: 10.5812/ijp.11546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Vardiabasis NV, Schlechter JA. Definitive Diagnosis of Children Presenting to A Pediatric Emergency Department With Fever and Extremity Pain. J Emerg Med 2017; 53:306-312. [PMID: 28992868 DOI: 10.1016/j.jemermed.2017.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/06/2017] [Accepted: 05/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Children who present to the emergency department (ED) with complaint of fever and new-onset joint or extremity pain can be a diagnostic dilemma for many emergency and consulting physicians. OBJECTIVES The purpose of our study was to identify the etiologies of pediatric fever and extremity pain presenting to a tertiary care pediatric ED and to define factors that were associated with advanced imaging, admission, and surgical intervention. METHODS The electronic medical records of children presenting to our institution's pediatric ED with fever and extremity pain were retrospectively reviewed. Data collected included demographic characteristics, laboratory studies, diagnostic imaging, need for admission, and surgical procedures. RESULTS The initial ED diagnosis was consistent with the definitive diagnosis 42% of the time. Children with the inability to bear weight on the affected limb were more likely to have a bacterial infection, such as osteomyelitis, septic arthritis, or intramuscular abscess (p = 0.016). An erythrocyte sedimentation rate >36 mm/hour and C-reactive protein levels >60 mg/L were found in children with osteomyelitis or septic arthritis (p = 0.043 and <0.001, respectively). Magnetic resonance imaging was ordered in 63% of children with multiple visits compared to 34% of children with a single visit (p = 0.05). CONCLUSIONS In addition to a thorough history and physical examination, a complete set of laboratory studies and diagnostic imaging is necessary to reach an accurate diagnosis. The inability to bear weight, elevated C-reactive protein levels, and an elevated erythrocyte sedimentation rate are associated with bacterial infection. Magnetic resonance imaging is a useful imaging modality in determining an accurate diagnosis.
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Affiliation(s)
- Nicolas V Vardiabasis
- Department of Orthopedics, Riverside County Regional Medical Center, Moreno Valley, California
| | - John A Schlechter
- Department of Orthopedics, Children's Hospital Orange County, Adult and Pediatric Orthopedic Specialists, Orange, California
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13
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Abstract
Context: The term growing pains describes a common, benign syndrome of recurrent discomfort that occurs in young children. First described in the 1800s, the etiology of this condition remains unclear. The peak incidence does not correspond to a time of rapid growth. Children typically report bilateral pain in the lower extremities that occurs late in the day or at night. Evidence Acquisition: The PubMed database was searched using the keywords growing pains, benign nocturnal limb pains of childhood, recurrent limb pain of childhood, and limb pain in childhood. Articles were also found by reviewing references from the initial PubMed search. Only English-language articles published from 1900 through 2016 were included in the review. Study Design: Clinical review. Level of Evidence: Level 3. Results: When a patient’s history is classic for growing pains and physical examination is normal, laboratory and radiographic evaluation are not needed to make the diagnosis. Findings typical for growing pains include bilateral lower extremity pain usually experienced in the early evening or at night. The pain is not caused by activity and will not cause a limp. Conclusion: Additional workup is warranted for children with an atypical history, systemic symptoms, or for those individuals with physical examination abnormalities such as allodynia, focal tenderness, joint swelling, or decreased joint range of motion. Management of growing pains generally consists of symptomatic care with massage and over-the-counter analgesics, as well as reassurance to children and parents about the benign, self-limited nature of this condition. This review article summarizes data on the epidemiology, etiology, and management of growing pains and provides a framework for distinguishing this entity from other causes of extremity pain.
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Affiliation(s)
- Patrick J Lehman
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Rebecca L Carl
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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14
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Wolf M. Knee Pain in Children, Part III: Stress Injuries, Benign Bone Tumors, Growing Pains. Pediatr Rev 2016; 37:114-8; quiz 119. [PMID: 26933226 DOI: 10.1542/pir.2015-0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Michael Wolf
- Pediatrics and Orthopedic Surgery, St Christopher's Hospital for Children, Philadelphia, PA
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Park MJ, Lee J, Lee JK, Joo SY. Prevalence of Vitamin D Deficiency in Korean Children Presenting with Nonspecific Lower-Extremity Pain. Yonsei Med J 2015; 56:1384-8. [PMID: 26256984 PMCID: PMC4541671 DOI: 10.3349/ymj.2015.56.5.1384] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/18/2014] [Accepted: 10/25/2014] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Although interest in the role played by vitamin D in bone health is increasing, little is known about the role of this vitamin in musculoskeletal pain in children. This study aimed to assess the prevalence of vitamin D deficiency in children presenting with nonspecific lower extremity pains. MATERIALS AND METHODS From 2011 to 2012, 183 children underwent evaluation for nonspecific lower-extremity pains. Patients with valid causes, such as fractures or transient synovitis, were excluded, as were those with underlying medical conditions, such as cerebral palsy and metabolic disease. Ultimately, 140 patients met the inclusion criteria. Levels of serum 25-hydroxy vitamin D [25-(OH)D], the ideal indicator of vitamin D status, were measured in these children. RESULTS Eighty-seven boys (62.1%) and 53 girls (37.9%) were included. The mean age at presentation was 5.2 years (range, 2-15). Serum 25-(OH)D levels were <10 ng/mL in 5.7% of patients, 10 to <20 ng/mL in 51.4%, 20 to <30 ng/mL in 37.9%, and ≥30 ng/mL in only 5.0%. Most patients visited the hospital in the winter (41.4%) (summer, 12.9%), and serum 25-(OH)D levels were also lowest in the winter (17.2±5.5 ng/mL). CONCLUSION This study found a high prevalence of vitamin D deficiency or insufficiency in Korean children with nonspecific lower-extremity pains, indicating a positive association between vitamin D deficiency and growing pains. More attention should be directed toward vitamin D and its role in the optimization of bone health.
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Affiliation(s)
- Min Jung Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Juyeob Lee
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jun Ku Lee
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sun Young Joo
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
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Abstract
NEED AND PURPOSE OF REVIEW Though cases of 'growing pains' are quite common in pediatric practice, very little attention has been given to it, even in the standard text books. The resultant confusion among practitioners regarding diagnosis and management of this condition needs to be addressed. METHODS USED FOR LOCATING, SELECTING, EXTRACTING AND SYNTHESIZING DATA PubMed search was performed using "growing pains "[All Fields] AND (("child"[MeSH Terms] OR "child"[All Fields] OR "children"[All Fields]) AND ("pediatrics"[MeSH Terms] OR "pediatrics"[All Fields] OR "pediatric"[All Fields])). Types of articles included are Review articles, Systemic Reviews, Randomized Controlled Trials, Practice guidelines and Observational studies. Google Scholar was also searched using the term "Growing pains in children". Relevant articles not included in the PubMed results were selected. Reference lists of selected studies were also screened to identify additional studies. MAIN CONCLUSIONS A fairly accurate diagnosis of growing pains can be made clinically, if the widely accepted diagnostic criteria are followed . A systematic approach, with due consideration of both inclusion as well as exclusion criteria, can avoid unnecessary (sometimes potentially harmful) investigations and medications. Reassurance remains the main stay in the management of 'growing pains'.
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Morandi G, Maines E, Piona C, Monti E, Sandri M, Gaudino R, Boner A, Antoniazzi F. Significant association among growing pains, vitamin D supplementation, and bone mineral status: results from a pilot cohort study. J Bone Miner Metab 2015; 33:201-6. [PMID: 24633492 DOI: 10.1007/s00774-014-0579-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/13/2014] [Indexed: 01/15/2023]
Abstract
The aim of our study was to analyze the possible relationship between growing pains, vitamin D levels, and bone mineral status. We enrolled 33 children affected by growing pains. Their pain intensity was evaluated through a questionnaire using the Wong-Baker Faces Pain Rating Scale for pain assessment. Serum 25-hydroxyvitamin D (25-OH-D), parathyroid hormone (PTH), and alkaline phosphatase levels were measured as well. A quantitative ultrasound assessment (QUS) was also done, measuring both the amplitude-dependent speed of sound (AD-SOS) and the bone transmission time (BTT), correlating, respectively, with bone density and with cortical thickness. After 3 and 24 months of vitamin D supplementation, we re-evaluated pain intensity and laboratory results. After 24 months we re-assessed QUS parameters. At the beginning of the study the children reported a mean growing pain intensity of 7.5 ± 1.6 SD. The mean values of 25-OH-D and PTH levels were 15.7 ± 6.9 ng/ml and 57.3 ± 27.3 pg/ml, respectively. The AD-SOS Z score was -0.53 ± 1.19 SD, and the mean value of the BTT Z score was -0.72 ± 0.96 SD. After the first 3 months of vitamin D supplementation we observed an increase in 25-OH-D levels (34.1 ± 17.8, p < 0.001) and a reduction in both PTH levels (47.3 ± 30.6, p = 0.135) and pain intensity (2.7 ± 2.2, p < 0.001). After 24 months we observed a further significant reduction in the pain intensity (3.9 ± 3.4, p < 0.001) and in PTH levels (43.7 ± 28.5, p = 0.004) and an improvement in the QUS parameters, in particular in BTT Z scores (p = 0.014). Our study suggests an interesting relationship between growing pains, vitamin D levels and bone mineral status.
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Affiliation(s)
- Grazia Morandi
- Department of Life and Reproduction Sciences, Pediatric Clinic, Giambattista Rossi Hospital, University of Verona, Piazzale Ludovico Antonio Scuro, 10, 37134, Verona, Italy,
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18
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Makay B, Kiliçaslan SK, Anik A, Bora E, Bozkaya Ö, Çankaya T, Ünsal E. Assessment of sleep problems in children with familial Mediterranean fever. Int J Rheum Dis 2014; 20:2106-2112. [PMID: 24641439 DOI: 10.1111/1756-185x.12339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS This study aimed to investigate sleep patterns, sleep disturbances and possible factors that are associated with sleep disturbances among children with familial Mediterranean fever (FMF). PATIENTS AND METHODS Fifty-one patients with FMF and 84 age- and sex-matched healthy controls were enrolled in the study. The patients who had an attack during the last 2 weeks were not included. Demographic data, FMF symptoms, disease duration, dose of colchicine, disease severity score, number of attacks in the last year, MEFV mutation and serum C-reactive protein (CRP) levels were recorded for each patient. A Children's Sleep Habits Questionnaire was performed. RESULTS The total sleep scores of the patients with FMF were significantly higher than the control group. Total sleep durations were similar between FMF patients and controls. Children with FMF had significantly higher scores regarding sleep-onset delay, sleep anxiety, night wakings and sleep-disordered breathing when compared to healthy controls. There was a significant positive correlation between number of attacks in the last year and sleep onset delay, night wakings and sleep disordered-breathing. Disease severity score and CRP levels were not associated with any of the subscale scores. The patients with exertional leg pain had significantly higher total sleep scores than the ones without. Furthermore, patients with exertional leg pain had significantly higher subscale scores regarding sleep onset delay, parasomnias and sleep-disordered breathing. CONCLUSION This study showed for the first time that children with FMF had more sleep disturbances than their healthy peers. Higher numbers of attacks and exertional leg pain were associated with poor sleep quality. In conclusion, this study underlines the need to assess and manage sleep problems in children with FMF.
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Affiliation(s)
- Balahan Makay
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylül University, Izmir, Turley
| | | | | | - Elçin Bora
- Department of Medical Genetics, Izmir, Turkey
| | | | | | - Erbil Ünsal
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylül University, Izmir, Turley
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Walters AS, Gabelia D, Frauscher B. Restless legs syndrome (Willis-Ekbom disease) and growing pains: are they the same thing? A side-by-side comparison of the diagnostic criteria for both and recommendations for future research. Sleep Med 2013; 14:1247-52. [PMID: 24157095 DOI: 10.1016/j.sleep.2013.07.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/03/2013] [Accepted: 07/04/2013] [Indexed: 12/12/2022]
Abstract
There has been no previous side-by-side comparison of the diagnostic criteria for restless legs syndrome (RLS) (Willis-Ekbom disease) and growing pains. In our review, we explore this comparison emphasizing overlaps and disconnects, summarize recent literature exploring the relationship between the 2 entities, and make suggestions for future research. There is considerable overlap in the diagnostic criteria for childhood RLS and growing pains. The literature also indicates that RLS and growing pains more commonly occur together than one would expect based on chance alone, and the family histories of RLS and growing pains often are overlapping. Leg rubbing to obtain relief from leg discomfort is common to both disorders, though walking to obtain relief seems unique to RLS. Childhood RLS also has been reported to be painful in up to 45% of cases. The development of standard diagnostic criteria is necessary to move forward in the field of growing pains research. A quantitative and validated rating scale for growing pains severity already exists. Because of the clinical and genetic similarity between RLS and growing pains, studies that parallel those previously performed in RLS patients are recommended for growing pains patients. For example, a genome wide association study in growing pains patients of all possible genes with particular attention to those identified as related to RLS and a therapeutic trial of medications known to be effective in RLS would be welcome. Abnormalities in vitamin D metabolism also may be common to both disorders.
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Affiliation(s)
- Arthur S Walters
- Department of Neurology, Sleep Division, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Gong YH, Ji CY, Shan JP. Longitudinal study on infants' temperament and physical development in Beijing, China. Int J Nurs Pract 2013; 19:487-97. [PMID: 24093740 DOI: 10.1111/ijn.12104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this longitudinal study is to explore the relationship between temperament and physical development among infants in Beijing, China. A total of 1117 term, normal and singleton infants were followed regularly for 12 months. Body weight and horizontal length were measured at 42 days and monthly from the third to twelfth month of their lives. Infants' temperament was assessed using the revised Chinese infants' temperament scale when the infants were 6 months. There was a significant difference on temperament dimensions between infants' genders (P < 0.05). Infants' weight and length were significantly related to their parents' weight and height. Infants with positive temperaments (easy and intermediate) were heavier than those with negative temperaments (difficult and slow to warm up) (P < 0.05). The horizontal length of boys was related to their temperament categories (P < 0.05). Infants' weight and length were significantly related to their temperament category and parents' weight and height.
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Affiliation(s)
- Yu-hua Gong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abstract
Musculoskeletal pain is one of the most common presenting symptoms at the pediatrician's office. Etiology ranges from benign conditions to serious ones requiring prompt attention. This article addresses entities that present as musculoskeletal pain but are not associated with arthritis. The most common nonarthritic conditions are benign limb pain of childhood (growing pains), hypermobility, overuse syndromes with or without skeletal abnormalities, malignancies, and pain amplification syndromes. The| initial decision process, diagnosis, and treatment options for each of these conditions are discussed.
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Affiliation(s)
- Peter Weiser
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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Champion D, Pathirana S, Flynn C, Taylor A, Hopper JL, Berkovic SF, Jaaniste T, Qiu W. Growing pains: twin family study evidence for genetic susceptibility and a genetic relationship with restless legs syndrome. Eur J Pain 2012; 16:1224-31. [PMID: 22416025 DOI: 10.1002/j.1532-2149.2012.00130.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Growing pains (GP) is a prevalent familial childhood disorder of unknown aetiology. Familial occurrence of GP, and individual and familial association of GP with restless legs syndrome (RLS) has been reported. METHODS We applied a twin family design to search for evidence of genetic susceptibility to GP, and for a genetic relationship between GP and RLS. The parents of 1843 twin pairs aged 3-16 years were administered a questionnaire, which identified 88 pairs with at least one twin individual fulfilling criteria for GP. Standard questionnaires for history of GP and RLS were completed for these twin pairs, their siblings and parents. RESULTS Twenty-five of 34 monozygotic (MZ) pairs were concordant for GP, compared with 12 of the 54 dizygotic (DZ) pairs. The casewise concordance was 0.85 and 0.36 for MZ and DZ pairs, respectively (p < 0.001). The lifetime GP prevalence for relatives of twins with GP was 51% for non-twin siblings, 47% for parents. Twenty-three percent of twin individuals with GP met RLS criteria compared with 8% of twin individuals without GP (p = 0.03). Of the twins with GP concordance, 19% met RLS criteria compared with 2% of twins with GP discordance (p = 0.01). In two MZ pairs, one had GP and the other RLS. The lifetime prevalence of RLS was 40% for mothers, and 24% for fathers and 18% for non-twin siblings. CONCLUSION This first twin family study of GP provides evidence for a genetic aetiology and for a genetic relationship to RLS.
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Affiliation(s)
- D Champion
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, Australia.
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