Anchorage Daily News

The vague and mysterious pains that wake school-aged children in the middle of the night confound even the most medically savvy parent. What are growing pains and why do children get them?

Truth is, many doctors believe these pains have nothing to do with growth at all.

"The general rule is that pediatricians don't use the term 'growing pains,' " said Dr. Thad Woodard, a pediatrician at Alaska Center for Pediatrics and the host of "Line One: Your Health Connection" on KSKA Public Radio. "They're mostly related to overuse. Kids are overactive. Sometimes they get pains from cramps or just soreness, but it's not related to growth."

Yet these pains happen during a time of dramatic physical development. They most often occur in children from 3 to 12 years old and in puberty, most commonly as an aching, cramping or throbbing in the legs, often behind the knees, around the shins and at the front of the thighs. Most children feel it at night or in the evening, presumably because they get too busy during the day to notice.

The Mayo Clinic estimates that 15 percent of children experience these occasional nighttime pains without apparent cause, though others put the number much higher at 25 to 40 percent.

According to the Mayo Clinic's Web site, www.mayoclinic.com, "Growing pains aren't a disease. In fact, the term 'growing pains' may be a misnomer because there's no evidence that growth hurts."

Perhaps not, but the pain is most definitely real. Many physicians believe it occurs because of the pounding the musculoskeletal system takes when children jump, run, leap and play, but it's hard to identify why it occurs only sporadically.

Pediatrician John Tappel of LaTouche Pediatrics said playing hard can certainly make children's muscles sore, but some of his patients report intermittent pain without an associated increase or change in activity levels. Bone growth doesn't cause these pains, he said, but perhaps the impact on surrounding connective tissues does.

"One of the proposed causes is that as your bones grow, it stretches the periosteum, the tough connective tissue that surrounds the bone, and that's what causes growing pains," he said.

Whatever the cause of these occasional pains, the treatment is essentially the same, he said. First make sure it doesn't involve things like fever, swelling or redness, and then reassure the child. Massage and stretching help, added Tappel, as does heat from a microwaveable heating bag filled with rice or beans, a far safer means of keeping the area warm than plugging in a heating pad.

Ibuprofen or acetaminophen can help alleviate the pain, too, though Woodard suggests avoiding pain medication whenever possible because "it may lead to the habit of using it more and more."

Rarely, the aches attributed to growing pains actually signal something more serious, like rheumatoid arthritis, so parents should monitor their children and consult a physician if the pain doesn't go away by morning, interferes with a child's normal activities, increases in frequency or is accompanied by other signs or symptoms like inflammation, rash, fatigue, weakness, tenderness, swelling, fever, loss of appetite and uncharacteristic behavior.

Anything involving the knee or ankle has to be looked at differently than a growing pain, said Tappel, because of the possibility of infection, injury or arthritis.

"We're mostly interested in making sure we're not missing something more dangerous," Woodard said. "Anything associated with swelling, heat and redness; pains that progressively get worst over time; things with an obvious deformity."

A medical history and examination usually give doctors enough information to make a diagnosis, though they sometimes ask for blood work, X-rays and other tests.

Certainly a child's response to touch while in pain can give parents and doctors a clue about its seriousness, according to an article about growing pains on www.KidsHealth.org, an online resource for parents, children and teenagers. "Kids who have pain from a serious medical disease don't like to be handled because movement tends to increase the pain. But those with growing pains respond differently -- they feel better when they're held, massaged, and cuddled."

As a rule of thumb, said Woodard, "If you can settle the child down and rub the area, that's probably a good sign."

Find Dawnell Smith online at adn.com/contact/dsmith or call 257-4587.

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