"Raat ko pair dukhne ki shikayat karta hai": growing pains in children, and when it is not

"Doctor sahab, raat ko pair dukhne ki shikayat karta hai. Din bhar theek rehta hai, raat ko rota hai."

I hear this almost every week in my evening OPD, and it is almost always the mother who says it, because she is the one awake at eleven at night rubbing a calf. Growing pains are a harmless pattern of aching in the muscles of both legs, at night, in a child who is otherwise completely well. Common is an understatement: NHS Greater Glasgow and Clyde's guidance on nocturnal leg pain in children records that benign leg pains of childhood cause "generalised leg aches in up to 30% of children between the ages of 2-12 years". In most of them nothing is wrong. But "most" is not "all", and the difference is a pattern you have already been watching for weeks.

You are not overreacting, and your child is not doing drama. Pain nobody can see is still pain, and a mother who noticed it happens at night and not by day has noticed exactly the detail a doctor needs.

What growing pains in children actually are (and what we still don't know)

The name growing pains is a leftover from a hundred years ago, and it helps to know why it is wrong. Growth does not hurt: children grow fastest in infancy and in the teenage spurt, and these pains line up with neither. What we describe is a pattern — aching in the muscles of both legs, at night, in an otherwise well child, with a normal examination and no lasting effect. The NHS says it in one line: "Growing pains is a term used for leg pain that is common in children aged 3 to 12. It's harmless and usually gets better on its own."

Beyond that I would rather be honest than sound confident. We do not know why one child gets this and his sister does not. The reasonable theories are a lower threshold for aching after a hard day, tight calf and thigh muscles, tiredness, and in some children low vitamin D. None is proven. When a parent asks "iski wajah kya hai", the truthful answer is that medicine has argued about this for a century without settling it.

Raat ko bachche ke pair dukhte hain: the pattern I hear most in Indore

The story is remarkably consistent. The child plays through the evening in the colony compound, cycles, runs, comes home, eats, sleeps. At ten at night, or at one in the morning, he wakes crying and holds his calves, the front of his thighs, or behind his knees. You rub the legs for fifteen minutes and he sleeps again. By morning he is running for the school van.

Two other details are typical. It comes in clusters, bad for a week then quiet for a month; and it is worse after very active days — summer holidays, sports day week, wedding evenings when children are up late on hard floors.

There is nothing to see: no swelling, no redness, no injury mark. That invisibility is why somebody in the family eventually says the child is exaggerating. He is not. He has a symptom without a sign, ordinary enough in medicine.

The pattern that reassures me

Six features together make up the pattern I find reassuring, and when a mother describes all of them I relax considerably. The most important is symmetry: the same NHS guidance notes that this pain "almost always occurs in both legs", so a child who hurts in one leg only, every time, is describing something else. The rest is about timing, site and how fast the child bounces back.

• Both legs, or alternating, not the same leg every time.
• Muscle, not joint. He points to the calf or thigh with his whole hand, not to a knee with one fingertip.
• Evening or night only. It never happens at school or during a cricket game.
• Gone by morning, with no limp, not even for the first few steps.
• Comfort works: massage, warmth and being held actually settle it.
• The child is otherwise well: eating, gaining weight, energetic, no fever.

When that picture holds together and my examination is normal, I usually order no test at all, and I say so clearly. A child does not need a blood report to prove nothing is wrong when history and examination agree.

The pattern that is not growing pains, and needs a look

Certain features move a child out of the growing pains box altogether, and they are why I would rather see a child once than reassure over the phone. The reference books treat this as a diagnosis reached by exclusion: the paediatric rheumatology chapter in Skills in Rheumatology, on the NIH's Bookshelf, stresses that in true growing pains "the physical examination, laboratory data, and radiological investigations are normal". Anything that breaks that rule needs explaining. The features that make me examine rather than reassure:

• One leg only, and the same spot every time.
• A limp, however slight, or a child suddenly wanting to be carried.
• Pain in a joint rather than muscle, especially one that looks swollen, feels warm, or that he protects.
• Morning stiffness, taking twenty or thirty minutes to loosen up. Growing pains do the opposite.
• Fever, weight loss, poor appetite, tiredness, paleness or unexplained bruises.
• Night pain that wakes him every night, always at the same point, needing medicine before he sleeps.
• Refusing to bear weight, or back pain, never brushed aside in a child.
• Pain continuing into the daytime, or following a fall.

A swollen joint matters particularly: juvenile idiopathic arthritis is defined in the StatPearls review on the same NIH Bookshelf as inflammatory arthritis in a child under 16 "lasting 6 weeks or longer" — so the six weeks a family spends waiting is exactly the window in which it becomes diagnosable.

One thing catches families out: children with a hip problem very often complain about the knee. If your child keeps pointing at a knee that looks normal, the hip needs examining. In children around 9 to 14, pain at the back of the heel after a lot of running is usually growth-plate irritation rather than growing pains or the adult condition in my article on heel pain and plantar fasciitis.

"Woh apne aap theek ho jayega": when that sentence is true, and when it delays a diagnosis

For classic growing pains that sentence is completely true, and the standard advice is deliberately modest — the same NIH Bookshelf chapter states that "management consists of reassurance and supportive analgesia". Most children stop having them by the early teenage years, and nothing else is needed. So the sentence is not wrong. What matters is who says it, and on what basis.

The problem is when it is said without anyone having looked at the child. "He'll grow out of it" is the commonest reason a child reaches my OPD months later with a limp the family had stopped noticing. That is not carelessness: a limp that appears gradually becomes normal to the eyes that see it daily.

So the fair version is this. Get the child examined once, then take the reassurance seriously. Reassurance after an examination is worth something; without one it is a guess, and the same guess whether the child is well or not. It is also why childhood conditions picked up early, from club foot to a limping hip, do far better than the same condition found late.

"Get the child examined once, then take the reassurance seriously. Reassurance after an examination rests on findings; without one it is a guess, and the same guess whether the child is well or not." — Dr. Arpit Maurya, MBBS, MS (Orthopaedics)

What I check when a child comes to my Indore OPD with leg pain

The check itself is mostly hands and eyes rather than machines. I start by letting you talk: which leg, what time of night, whether it wakes him, how he is next morning, whether he has lost weight. Your description is the most valuable part of the consultation. Then I watch him walk, run a few steps, get up from the floor and stand on one leg. A limp a family has stopped seeing is obvious within ten seconds of watching a child run.

Then I compare both legs for muscle bulk and length, and press point by point over the bone, because a bone that hurts at one fingertip is very different from a calf that aches all over. I move every joint, and always examine the hips even when the child says the pain is in the knee. I check the spine, and do a general examination: temperature, pallor, glands, bruising, and weight against previous records.

Tests come only if the examination points somewhere: a blood count with inflammatory markers, a vitamin D level, or an X-ray. I do not scan a child because a parent is anxious. I scan because my hands found something.

Ghar pe abhi kya karein — what to do at home right now

• Halke haath se maalish. Gentle massage of the calf and thigh with warm oil for ten to fifteen minutes. Comforting a child in pain is not spoiling him, and here it is the most effective thing you have.
• Garam sikai. A warm compress over the aching muscle before bed, wrapped in cloth so it is comfortable, not hot.
• A bedtime stretch. Calf and thigh stretches for both legs, held gently for twenty to thirty seconds each, every night rather than only on bad nights.
• Paracetamol occasionally on a bad night is reasonable. If your child needs a painkiller every night to sleep, that frequency is itself a finding, so bring it to me instead.
• Check the shoes. Worn-out school shoes, or bathroom chappals worn all day on tiled floors, make active legs ache more. Some cushioning, replaced when the sole flattens, helps more than parents expect.
• Write it down. Date, which leg, what time, and whether he walked normally next morning. Two weeks of that tells me more than most tests.

Bringing your child in: what an evening visit to D.R. Healthcare, Indore looks like

Most of these consultations end with me telling a mother her child is completely fine, showing her the two stretches, and explaining what would make me want to see him again. That is a good outcome, not a wasted visit.

You can book an evening appointment at D.R. Healthcare, Indore, or send the details on WhatsApp if you would rather describe the pattern first. If you are unsure whether it can wait, call 7869709075 and ask. We see patients Monday to Saturday, 6 to 8 PM, which works around school and homework.

Questions patients ask us