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It's 10pm and your child is in tears, clutching their legs. "My legs hurt." You rub them, offer comfort, and eventually they fall back asleep. By morning, they're running around like nothing happened. Sound familiar?
Growing pains are one of the most common childhood complaints, affecting an estimated 25-40% of kids between the ages of 3 and 12. Despite the name, growing pains aren't actually caused by growing. And while they're usually harmless, they can be confusing and distressing for both kids and parents.
What Are Growing Pains?
Growing pains are recurrent episodes of leg pain that typically occur in the late afternoon or evening, often waking a child at night. They're a real physiological phenomenon, not something kids make up or exaggerate.
Typical characteristics include:
- Pain in both legs (rarely just one side)
- Most commonly felt in the front of the thighs, calves, or behind the knees
- Pain that comes and goes, with pain-free days or weeks in between episodes
- No pain or limitation during the day
- No swelling, redness, or warmth in the affected areas
- Episodes that are relieved by massage, stretching, or warmth
What Actually Causes Them?
Despite years of research, the exact cause of growing pains isn't fully understood. The name is misleading because there's no evidence that bone growth itself causes pain. Current theories include:
Muscle fatigue and overuse. The most widely accepted explanation is that growing pains are related to muscle fatigue from a day of running, jumping, and climbing. Kids who are very active tend to have more frequent episodes.
Lower pain thresholds. Some research suggests that children who experience growing pains may have a lower pain threshold than peers, making them more sensitive to the normal muscle aches of an active day.
Musculoskeletal factors. Tight muscles (especially in the calves and hamstrings), flat feet, and hypermobility have all been associated with growing pains. These factors can contribute to muscle strain during activity that manifests as pain later.
Vitamin D deficiency. Some studies have found an association between low vitamin D levels and growing pains, though this is still being researched.
When It's Not Growing Pains
Not all leg pain in children is growing pains. There are some red flags that suggest something else might be going on and warrant a prompt visit to your pediatrician:
- Pain in only one leg consistently. Growing pains are typically bilateral.
- Pain during the day that limits activity. If your child is limping, refusing to walk, or unable to play, this goes beyond growing pains.
- Swelling, redness, or warmth in a joint. These are signs of inflammation that need evaluation.
- Fever along with leg pain. This combination can indicate infection or inflammatory conditions.
- Pain that's getting progressively worse. Growing pains come and go. Pain that steadily worsens needs investigation.
- Pain that doesn't respond to massage or rest. Growing pains typically feel better with comfort measures.
- Pain localized to a specific spot. Growing pains tend to be diffuse. Pain in one specific spot, especially over a bone, may indicate a different cause.
How Pediatric PT Can Help
While growing pains are not a serious medical condition, physical therapy can help reduce their frequency and intensity. A pediatric PT approaches growing pains by addressing the musculoskeletal factors that contribute to them:
Stretching programs. Tight calf muscles, hamstrings, and quadriceps are commonly found in kids with growing pains. A regular stretching routine, especially before bed, can significantly reduce the frequency of episodes.
Strengthening weak muscle groups. If certain muscles are weak, others have to compensate, leading to more fatigue by the end of the day. Targeted strengthening helps distribute the workload more evenly.
Addressing flat feet or alignment issues. If flat feet or other alignment concerns are contributing to muscle strain, your PT may recommend exercises, footwear changes, or orthotics.
Activity modification. Your PT can help you adjust your child's activity levels on high-pain days and build a gradual activity progression that reduces overuse.
Education and reassurance. Understanding what growing pains are (and what they aren't) can reduce anxiety for both you and your child. A PT can help you develop a pain management plan that empowers your child to cope with episodes when they occur.
What You Can Do at Home
- Massage the legs. Gentle massage of the calves, thighs, and behind the knees during an episode can provide significant relief.
- Apply warmth. A warm bath before bed or a heating pad on the affected area can help relax tight muscles.
- Stretch before bed. A simple 5-minute stretching routine targeting the calves, hamstrings, and quads can reduce the frequency of nighttime episodes.
- Ensure adequate hydration. Dehydration can contribute to muscle cramping and fatigue. Make sure your child is drinking enough water, especially on active days.
- Consider vitamin D. Talk to your pediatrician about checking your child's vitamin D levels, especially if episodes are frequent.
- Validate the pain. Growing pains are real and they hurt. Let your child know you believe them and that you're there to help.
When to See a Pediatric PT
Consider a PT evaluation if:
- Growing pains are happening multiple times a week
- They're significantly disrupting your child's sleep
- Your child has flat feet, hypermobility, or tight muscles
- The pain seems out of proportion to their activity level
- You want a proactive plan to reduce episodes
At Coral Care, our PTs work with families to build practical, play-based programs that help kids with growing pains. We'll evaluate your child's flexibility, strength, and alignment, and give you a home program that fits into your bedtime routine. Schedule a free consultation to learn more.
Frequently Asked Questions
Gentle massage of the calves, thighs, and behind the knees during an episode helps, as does warmth from a warm bath or heating pad. A simple five-minute bedtime stretching routine for the calves, hamstrings, and quads can reduce how often episodes happen. Keep your child well hydrated, especially on active days, and validate that the pain is real.
See your pediatrician promptly if pain is consistently in only one leg, occurs during the day and limits activity, comes with swelling, redness, or warmth in a joint, is accompanied by fever, gets progressively worse, doesn't respond to massage or rest, or is localized to one specific spot over a bone. Growing pains are typically in both legs, come and go, and ease with comfort measures.
Despite the name, there's no evidence that bone growth itself causes the pain. The most widely accepted explanation is muscle fatigue from a day of running, jumping, and climbing, which is why very active kids tend to have more episodes. Tight calf and hamstring muscles, flat feet, hypermobility, a lower pain threshold, and possibly low vitamin D have all been associated with growing pains.
Growing pains are recurrent episodes of leg pain that typically occur in the late afternoon or evening and can wake a child at night, then disappear by morning. They affect an estimated 25 to 40% of kids between ages 3 and 12 and are a real physiological phenomenon, not made up. They usually affect both legs, most often the front of the thighs, calves, or behind the knees, with pain-free stretches in between.
