11/12/2023
👉Growing pain in Pediatrics and Red Flags
🟡Timing of pain:
• Growing pain usually in the evening, with isolated
daytime episodes
• The pain resolves by morning
• Comes and goes, with pain-free periods
• May occur after significant
activity, such as jumping, soccer game, gymnastics.
• May wake from sleep
🚩Red Flag: If occurs only during the day --> pathologic and must be investigated
🟡Location of pain: growing pain is often bilateral, no specific location, more common in lower extremities (thighs and shins) but can occur in conjunction with upper extremities. can be associated with headaches and abdominal pain.
🚩Red Flags: If associated with systemic symptoms for example, fever, limping, and weight loss--> rule out malignancy, bone pain can be the only initial manifestation of leukemia in pediatrics
🟡 Physical activities: No limitations of physical activities
🚩Reg Flag: Limitations of physical activities
🟡Physical examination: Completely normal in cases of isolated or classic growing pain, no limping, no joint swelling.
📊Laboratories: Are not indicated in classic cases. Labs and imaging studies are normal including CBC and ESR.
👍Managment: Reassurance: Heat massage, analgesics such Ibuprofen or acetaminophen, follow up if any worsening.
Pediatric Board Study Guide, 3rd edition. 2024 "under publications"
Springer