Growing Pains /

Nocturnal Limb Pain of Childhood

01 In Brief

Occurs in 30% of healthy children between the ages of two–12 years. The cause is unknown and despite its name it is unlikely to be related to growth. It tends to occur more frequently on days where there is a lot of physical activity. Characteristically it is located at in muscles of the legs and does not involve the joints. It occurs in during late afternoon, early evening and occasionally wakes a child at night.  It is always resolved by the morning the diagnosis is made by clinical assessment; and tests are usually not necessary. Treatment is by simple measures such as leg massage, heat packs, a warm bath and occasionally simple pain relief.

02 What Do I Need To Know?

  • Growing pains are also known as benign nocturnal limb pain of childhood. It has been attributed to rapid growth however the peak age of growing pains is six years which is not a period when children grow rapidly. Some studies suggest that it is a pain syndrome and that the pain threshold in affected children is lower compared to other normal children.
  • Other suggested causes include overuse syndrome with bone fatigue, changes in blood flow and anatomical and mechanical factors such as hypermobility, however the studies are inconclusive.
  •  It is often worse when a child has been physically active but this is not always the case. Parents may be able to predict which activities are more likely to result in their child complaining of pain; it is reasonable to give the child some mild analgesic before bedtime.
  •  The site is of the pain is typically in the front of the thigh, the calf muscles, shins and the muscles in the back of the knee. It is almost always bilateral. It can last from minutes to hours.


  • You should consult your doctor if the following occurs:
  •  Pain is persistent and causing the child distress,
  •  Localised to only one leg
  •  Present in the morning,
  •  Associated with joint pain or joint swelling
  •  Related to an injury,
  •  Other signs are present such as local signs of swelling, and tenderness, redness,  limping and or systemic symptoms of fever, loss of appetite and loss of weight weakness and general fatigue.
  •  If these symptoms occur it is likely that your doctor will perform investigations including blood tests and an x-ray.



  • Reassure your child that the pain is real and that it makes them distressed.
  • Symptomatic treatment should be offered such as a local massage and a warm bath before bedtime.
  • Keep a diary and make note on the occasions when the growing pains occur and what happened in the daytime before.
  • Occasionally in some children the pain is problematic and requires pain relief such as paracetamol and ibuprofen. In particularly difficult cases long acting anti-inflammatories such as naproxen can be helpful.
  • Others suggested interventions include a diet high in calcium and vitamin D however this has not been subjected  to trial. In small controlled studies shoe inserts in children with abnormal posture have been effective. These intervention should only be considered on a case-by-case basis.
  • The natural history of growing pains is benign and most resolve by adolescence.

03 What Others Say

  • Arthritis research UK information sheet

 Growing pains: advice for parents and carers

  • Mayo clinic provides an excellent summary of current knowledge

Growing Pains

  • Better health Channel fact sheet 

Growing Pains


04 I Want To Know More

  •  Uziel Y. et Hashke P. :A review; Paediatric Rheumatology 2007,5:5

Growing pains in children:

  • Arthritis research UK

 Growing pains: a practical guide for primary care

Kid's resources

 An information booklet by the Arthritis Research campaign UK written for 5 to 10 year olds:

 Growing pains

The information published here has been reviewed by Flourish Paediatrics and represents the available published literature at the time of review.
The information is not intended to take the place of medical advice.
Please seek advice from a qualified healthcare professional.
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Last updated: 13/06/2011 by Dr ElizabethHallam*