Background and objectives: Up to a third of children can be diagnosed with growing pains, but there is great uncertainty about 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 inception to January 2021. Study selection included peer-reviewed articles or theses referring to “growing pain(s)” or "growing pain(s)" in relation to children or adolescents. Data extraction was performed independently by 2 reviewers. Results: 145 studies and 2 diagnostic systems (ICD-10 and SNOMED) were included. Defining 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, physical examination, and investigations. There was extremely poor consensus among studies as to the basis for a diagnosis of growing pains. The most consistent component was lower extremity pain, mentioned in 50% of sources. Evening or nocturnal pain (48%), episodic or recurrent course (42%), normal physical assessment (35%), and bilateral pain (31%) were the only other components mentioned in more than 30% of the articles. In particular, more than 80% of studies did not refer 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 pains. Clinicians should be careful about relying on the diagnosis to direct treatment decisions. |
Comments
We often hear the phrase "growing pains" used by the general public to describe muscle or joint pain in young people and the term is also used by health professionals. However, researchers have found that there is no consistent medical definition of the condition behind a diagnosis.
An extensive review of the medical literature by researchers at the University of Sydney found that there is no agreement between researchers and doctors about what growing pains really are, what they mean, how they are defined and how they should be diagnosed.
Researchers say growing pains may be a medical misnomer . Surprisingly, more than 93 percent of the studies did not refer to growth when defining the condition. More than 80 percent of the studies did not mention age in their definition.
The findings have led researchers to recommend that doctors and other researchers not use the term growing pains as a stand-alone diagnosis until a clear definition supported by evidence has been established.
Growing pains are considered one of the most common causes of recurrent musculoskeletal pain in children and adolescents. Some studies suggest that up to a third of children experience the condition at some point in their lives.
The term first emerged in 1823 in a book called ’Maladies de la Croissance’ (’diseases of growth’). “Thousands of children are diagnosed with growing pains by their healthcare professional, but we were curious: what does that diagnosis really mean?” said lead author Dr Mary O’Keeffe, from the University of Sydney’s Institute of Musculoskeletal Health.
The researchers pulled information from 147 studies that mentioned growing pains. The goal was to see how researchers defined the term and whether there were any detailed criteria that led to a diagnosis. The medical literature included research of many types, including systematic reviews, editorials, observational studies, case-control studies, and theses.
"What we found was a little worrying : that there is no consistency in the literature about what ’growing pains ’ means ," said Professor Steven Kamper, of the University of Sydney’s Faculty of Health Sciences and District Health. Nepean Blue Mountains Local.
“The definitions were really variable, vague and often contradictory. Some studies suggested that growing pains occurred in the arms or lower body. “Some said it was muscles, while other studies said joints.”
Only seven studies, less than 10 percent of the studies examined, mentioned pain-related growth. More than 80 percent of the studies did not mention a young person’s age at the time the "growing pains" occurred. There was also no widespread agreement or lack of detail about where the pain was located or when it occurred.
- Fifty percent of the studies mentioned "growing pains" as being located in the lower extremity, while 28 percent reported specifically in the knees.
- Forty-eight percent of studies reported that "growing pains" occur during the afternoon or night and 42 percent reported that they were recurring.
"What this study found was that while ’growing pains’ is a very popular label used to diagnose musculoskeletal pain, it means very different things to different people," said lead author Professor Steve Kamper.
"This level of uncertainty means that doctors do not have clear guidance or criteria for when the label ’growing pains’ might be appropriate for a patient."
The study also raised new questions about whether growing pains have any connection to growth itself in bones or muscles. “There is a lack of evidence or inconsistent information about growing pains as a condition, and how it is associated with growth, or even the cause of the pain,” Dr. O’Keeffe said. "There is a real opportunity to understand this condition, given how widespread the use of the term is, or whether there is even a need to use this term."
