🦷 Growing Pains (Benign Nocturnal Pains)
• Age 3-12 years, bilateral lower extremities (thighs, calves)
• Pain late day or night, no limp, normal exam
• Massaging relieves pain; no daytime symptoms
• Diagnosis of exclusion – never unilateral or persistent daytime pain
🦴 Overuse Syndromes
• Shin splints (medial tibial stress syndrome): diffuse tibial tenderness, worse with activity
• Little League elbow: medial epicondyle apophysitis (overhead throwing)
• Sever disease: calcaneal apophysitis (heel pain, age 6-10)
• Panner disease: capitellar osteochondrosis (age 5-10, lateral elbow)
⚠️ Red Flags – Serious Causes
• Night pain (especially awakening from sleep) → bone tumor
• Refusal to bear weight + fever → septic arthritis/osteomyelitis
• Unilateral, persistent, progressive pain
• Localized bony tenderness, swelling, warmth
• Constitutional symptoms (fever, weight loss)
🩺 Other Diagnoses
• Nursemaid's elbow (radial head subluxation): age 1-4, pulled arm, refusal to use arm
• Viral myositis: severe calf pain, difficulty walking, post-influenza (type B)
• Osteomyelitis: fever, localized bone pain, elevated CRP/ESR; MRI is best imaging
• Fibromyalgia: chronic widespread pain, tender points, fatigue, sleep disturbance
📌 Decision strategy: Growing pains are bilateral, nocturnal, relieved by massage, and have normal exam. Night pain that awakens child is concerning for tumor. Nursemaid's elbow: history of pull, exam normal x-ray, reduction maneuver.