Growing Pains: When Should Parents Worry?
Is it growing pains or something worse such as juvenile rheumatoid arthritis?
Arthritis Often Missed
Lehman regularly sees young patients with all types of arthritis, but especially juvenile rheumatoid arthritis. It's an unpredictable disease with symptoms that can worsen or disappear without clear reason, he explains. In general, children with JRA have one or several symptoms including joint pain, joint swelling, and joint stiffness early in the disease. Most children have good and bad days.
He's seen it too many times: "Virtually every child with arthritis has been dismissed as 'just having growing pains,'" Lehman tells WebMD. "And because proper diagnosis is delayed -- sometimes for months -- there are irretrievable circumstances."
Most children with juvenile rheumatoid arthritis (70% to 90% of them) will recover without any serious disabilities. But some symptoms can continue into adulthood, such as stiffness, pain, limits on physical activity, and chronic arthritis.
In the worst cases, the length of the child's leg can be affected. That happens when inflammation in an untreated joint increases blood flow in that joint, he explains. "With that increased blood flow, the bone will grow bigger. One leg will actually be longer than the other. It can affect walking, [and] cause hip and back problems."
"The whole key is to understand what growing pains are, and what they aren't," says Lehman. "A child with growing pains will have no daytime pain, no limp, no other abnormality. But when the child gets pain during the day -- and the pains are persistent or abnormally severe -- the child needs to see a doctor."
Often, children with JRA are mistakenly sent to an orthopaedic surgeon, Vogler tells WebMD. "If the pain is misinterpreted as a hairline fracture, the child gets a cast. With JRA, immobilizing the joint is counterproductive. The treatment should involve anti-inflammatory medications and working on regaining lost range of motion."
For most kids, getting spoiled by late-night attention is the biggest problem with true growing pains, Vogler explains. "The growing pains take on a life of their own. Children find out that crying at night gets mom's attention, and it becomes positive reinforcement. Parents need to be aware that most kids with growing pains don't have them every single night. It's fine to reassure, but don't overindulge."