What are growing pains?

I remember in residency, when seeing a child for a knee pain or limp and the evaluation was normal, I would usually say "growing pains". The moms and dads would already have heard about the diagnosis but would be at ease when I would agree. I would compare this to seeing a 40 year old male that comes in for left sided chest pain and I clear him of heart disease then say its just "stress". To throw all the potential diagnosis under one obscure title of stress is not acceptable to an intelligent educated american. Same thing with the diagnosis of growing pains. In the case of my nephew who is 6, his doctor said the limping he was suffering from is probably just that. This is probably true but I think an educated parent would like to know a more specific diagnosis. When the knees are painful, we worry about the patella. Sometimes worry about Osgood Schlatter Disease where the thigh muscles (quads) stay tight and the thigh bone (femur) gets longer. This would make the muscle pull at it's insertion points on the knee with more force causing a lump to form.




In some cases, knee pain and a limp at my nephews age could be something worse like Perthes Disease (or at a later age, a SCFE). Both of these are not common but since the results are bad, they have to be considered if limping doesn't go away or gets worse. Little James just started baseball 6 weeks ago which makes me feel better that we have a reason for the pain but I will probably be getting an xrays later. (Don't like the radiation exposure but I'll watch him closely and did ask my cousin to video tape his training next time.)

As my patients know, history is 80% of the diagnosis and I think baseball will be the reason for the pain (overtraining). The Saguil Approach is to start with a working diagnosis, evaluate for abnormality, watch the training pattern, surface and shoe type, consider an xray, rule out groin issues and consider 1-2 weeks off to see the results. I suggested that if it is due to baseball practice, try childrens motrin/advil three times a day the day of and the day after practice. Pain that breaks through that conservative treatment will mean we have a bigger issue to be investigated faster.

To note, if there is no limp and just complaints, may consider "secondary issues" like he doesn't like the sport or the coach, or worse, there's a bully around.