Idiopathic, benign lower extremity discomfort that occurs in children during the growth phase, especially during the faster growth phase, occurs in about 15% to 30% of children. It is reported to be more common in girls, usually with nocturnal onset, waking up with pain, and severe complaints of severe pain requiring massage or rubbing for several minutes to ten minutes, which can be relieved on its own, mainly involving the lower extremities. This kind of pain does not lead to dysfunction or organic changes and can heal on its own without leaving any sequelae. The etiology is unknown and may be related to genetic, functional or structural factors such as hyperactivity. In childhood, growing pains are in third place after headache and stomach pain.
Key points in the consultation
Age of onset: Mostly seen in children between 4 and 10 years of age, with more common onset at school age or prepubescent age. It occurs in children who are intolerant or sensitive to pain and active.
Onset and frequency: The pain is usually nocturnal, often waking up from sleep, unilateral or bilateral limbs are possible, bilateral is common, typically alternating, usually several times a month, 1-2 times/week on average, but also once a few months, lasting 2-3 years. A longer medical history is consistent with growing pains, and a long medical history helps to exclude serious organic disease, which develops after a period of time with objective changes in signs.
Location: The knee joint is the most commonly involved, followed by the ankle joint, the tibiofibular stem near the knee and ankle joints, and not infrequently the elbow and wrist joint sites, and also complaints of foot and toe pain.
Nature of pain: The pain is usually vague and poorly localized during the attack, intermittent and lasting from a few minutes to ten minutes. It can be relieved by comfort, massage or distraction.
Relevant history questioning: Does the child have any generalized medical appearance? Is there any joint deformity or stiffness? Does the patient have mobility problems or lameness? Growing pains rarely interfere with activity, do not affect gait or general condition, and return to daily activities immediately after the onset of pain.
Key points of physical examination
1.General condition: mental condition, nutrition, and the presence of wasting diseases.
2. General examination: Is there any general disease? Is there any limping gait? Is there any tilt of the pelvis? Is there any atrophy of the muscles of the lower limbs?
3.Pressure pain: palpation of the limb or motor system to check for pressure pain.
4.Joint movement: Check whether there is swelling, deformity and stiffness of the limb and joint movement disorder? Lower limb pain should not be neglected especially for hip joint examination.
Auxiliary examinations: If the history is atypical or there are positive signs during the examination, x-ray films and laboratory tests are needed. Such as.
1, blood routine and C-reactive protein, to understand whether the child has acute inflammation or anemia and other conditions
2.Rheumatoid factor, anti-“O”, sedimentation, antinuclear antibody, immune panel (IgG, IgM, IgA), leukocyte antigen system (HLA) test, etc.
3. CT tomography can detect microscopic bone lesions such as osteoid osteoma.
4.MRI examination can understand the lesions in and around the soft tissues and bone marrow cavity of the knee joint.
Diagnostic and differential diagnosis points
Intermittent nocturnal pain that occurs mainly during the growth period, alternating lower extremity pain in both knee joints, lasting for a few minutes to ten minutes, relieving on its own, not affecting gait or general health status, a long medical history and excluding organic lesions, and negative results of further examinations, can be initially diagnosed as growing pain. The main differential diagnosis should consider that nocturnal pain can also be due to tumors, such as osteoid osteoma, hematologic tumors, osteogenic osteosarcoma, or Ewing’s sarcoma. Malignant bone tumors cause limited pain, are often complicated by soft tissue masses, are progressively worse, and have a later onset than growing pain.
Key points of medical history taking
Nature and duration of pain: (including age of onset, location, duration and frequency of pain episodes, nature of pain, etc.), presence of fever, abnormal walking gait, limb deformity, and joint mobility disorders.
Auxiliary findings: x-ray excluding bone destruction or occupying lesions.
Outpatient emergency treatment
1.Treat symptomatically with hot compresses and painkillers.
2.Communicate with the family and explain that the disease is benign, self-limiting and generally does not leave sequelae, but inform the family that if there is any change in clinical manifestations, they should bring the child for follow-up in a timely manner.