RECURRENT NOCTURNAL LIMB PAINS

These are also called "growing pains" or "idiopathic" (of unknown cause) limb pains. They are remarkably common in children usually in the primary school age group. The history is very characteristic. After an active day the child goes off to sleep normally but wakes after some hours with pain in the legs usually localised chiefly to the shins but sometimes more centred on the knees or ankles. Much less commonly there may be some pain in in the arms as well.

Cause

This remains a mystery. It is not clear from where the pain truly arises or what causes it. Investigations The characteristic history and the complete lack of clinical findings are so typical that the diagnosis can usually be made confidently without subjecting the child to any uncomfortable tests. If there is any doubt at all, more serious arthritic and other conditions can readily be excluded with some simple blood tests and possibly an X-ray of the painful areas.

Treatment

It is important for the child and all others concerned, including for instance grandparents, to understand that although the pains may be quite severe and distressing they are benign and will go away in time. When the pain occurs most children find local warmth and massage of the affected limbs soothing and that may be all that is needed. If the pattern is for the pain to persist more than a few minutes it is wise to give a dose of paracetamol as soon as the pain occurs, this usually brings relief in about 15 minutes. Few children get the pains repeatedly on consecutive nights so long term treatment is seldom apprpriate. However, parents do learn the pattern of the pain in their child and can sometimes predict which nights the child is likely to get pain. If that is the case it may be worth giving a dose of a pain relieving medicine at bedtime. Paracetamol suspension is usually tried first and can be effective but it has a rather short duration of action, about four hours, so may not prevent the pain. A drug with a longer action such as ibuprofen suspension may be more effective.

Outlook

Growing pains virtually never evolve into any serious form of arthritis or other disease. They remain troublesome for a while and then disappear as mysteriously as they came.