Are growing pains real? A review of 145 studies finds no agreed definition

Growing pains are real in the sense that many children genuinely get recurrent, benign limb aches — but the label is far vaguer than it sounds, and there is little scientific agreement on what actually qualifies. A 2022 scoping review that gathered every usable definition in the medical literature found "extremely poor consensus between studies as to the basis for a diagnosis of growing pains" [s1]. And despite the name, the evidence does not show the pains are caused by growth [s1][s2].

What the review found

The researchers searched eight databases and six diagnostic classification systems from their inception to January 2021, and included 145 studies plus two formal diagnostic systems, ICD-10 and SNOMED [s1]. They grouped the definitions into eight categories — pain location, age of onset, pattern, trajectory, types and risk factors, relationship to activity, severity, and physical examination — and then counted how consistently each feature was used [s1].

The result was striking for how little agreement it revealed. The single most consistent component was lower-limb pain, and even that appeared in only 50% of sources [s1]. Pain in the evening or at night was mentioned by 48%, an episodic or recurrent course by 42%, a normal physical assessment by 35%, and pain in both legs by 31% — and those five were the only components named in more than 30% of the literature [s1]. Notably, more than 80% of studies made no reference to an age of onset at all [s1]. In other words, a diagnosis that up to a third of children may receive rests on features that a bare majority — or a minority — of authors even bother to specify [s1].

What is reasonably agreed

Strip the inconsistency away and a workable clinical picture remains, and it is roughly what the NHS describes: growing pains typically affect children aged 3 to 12, come on in the evening or at night, involve both legs, and have gone by morning, and they are harmless and not actually caused by growth [s2]. The important word is harmless: growing pains are, in practice, a diagnosis of exclusion — a label applied to benign, recurrent leg pain in a well child whose examination is normal, once other causes have been considered [s1][s2].

That the two formal coding systems, ICD-10 and SNOMED, were the only diagnostic frameworks the review could find is itself telling: an entity carried in the world's medical classifications still lacks the agreed criteria that most named conditions have, which is why the review's authors set out to map the definitions in the first place [s1]. For parents, the upshot is that a doctor saying "growing pains" is usually saying something reassuring and specific — a normal, self-limiting pattern with nothing worrying on examination — rather than pointing to a single well-defined disease [s1][s2].

What helps, when it is growing pains

Because the pains are benign and pass on their own, the NHS advice is low-key comfort rather than treatment: gently massage the child's legs, put a covered hot water bottle or heat pack on the sore area, and give children's ibuprofen or paracetamol to ease the pain [s2]. The condition, it notes, "is harmless and usually gets better on its own" [s2]. There is no medicine that shortens the underlying pattern, and none is needed.

The signs that are not growing pains

Because the diagnosis works by exclusion, the features that argue against it matter more than the ones that fit. The NHS advises seeing a GP if a child has pain in one leg only; leg pain in the morning, or when walking or taking part in activities; pain bad enough to stop them walking or that makes them limp; pain in a single joint such as a knee or ankle; a rash, swelling or unusual bruising on the legs; leg pain together with a high temperature; unusual tiredness or sleepiness; or is off their food or losing weight [s2]. Each of those points away from benign growing pains and toward something that needs proper assessment [s2].

How to read this

The takeaway is not that growing pains are imaginary, but that the term is a loose clinical shorthand rather than a precise disease [s1]. It reasonably describes benign, bilateral, evening leg aches in a well child with a normal examination — and it explicitly is not an explanation involving growth [s1][s2]. Treated that way, the label is useful mainly as a reminder to check that nothing else is going on: pain that is one-sided, daytime, joint-centred, or accompanied by swelling, fever or feeling unwell is a reason to look further, not to reassure. This article is informational and not medical advice; a child with persistent, worsening or one-sided limb pain should be seen by a clinician.