Pain Growing Pains in Children: Does Growing Really Cause Leg Pain?

Creator: Mark Reyneker, BTech (Podiatry), MSc (Palaeontology), Registered Podiatrist, Foot & Gait Specialist | Founder & Clinical Director, Family Podiatry Centre
Published: 2026-09-11T06:17:00+08:00

11 September 2026

By Mark Reyneker, BTech (Podiatry), MSc (Palaeontology), Registered Podiatrist, Foot & Gait Specialist | Founder & Clinical Director, Family Podiatry Centre

Growing pains are real. But are children actually hurting because they are growing?

Few childhood diagnoses are as familiar as “growing pains.”

A child wakes at night complaining that their calves or thighs hurt. There has been no obvious injury. Nothing looks swollen. A parent massages the legs and, by the following morning, the child is running around normally again.

For generations, the explanation has been simple:

“It’s because you’re growing.”

There is just one major problem.

We have surprisingly little evidence that normal childhood growth causes these pains.

In fact, some of the strongest modern research examining the question directly has found no relationship between episodes of so-called growing pains and periods of rapid growth.

The pain experienced by these children is very real.

The explanation contained in the name may not be.

That distinction is important because calling unexplained childhood leg pain “growing pains” can sometimes bring the diagnostic process to an end before anyone has asked the more useful question:

Why does this particular child’s leg hurt?

What Are “Growing Pains”?

Growing pains are generally used to describe recurrent lower-limb pain in otherwise healthy children, most commonly during the preschool and early school years.

The classical description includes:

aching or throbbing pain in the calves, thighs, shins or behind the knees
symptoms occurring later in the day or at night
episodes that come and go
normal activity between episodes
no obvious joint swelling
no persistent limp
no significant restriction of movement
a normal musculoskeletal examination

The pain can sometimes be intense enough to wake a child from sleep.

By morning, however, the child is usually completely comfortable.

That pattern is reassuring.

But even this apparently straightforward definition has a problem:

Medicine has never really agreed on what “growing pains” are.

A major 2022 scoping review published in Pediatrics examined 145 studies and two diagnostic classification systems.

The researchers found remarkably poor agreement regarding the definition.

Lower-limb pain was mentioned in only 50% of definitions.

Evening or night pain appeared in 48%.

An episodic or recurrent course appeared in 42%.

A normal physical examination appeared in only 35%.

Bilateral pain appeared in 31%.

And perhaps the most remarkable finding of all:

93% of studies defining “growing pains” did not mention growth.

That is extraordinary for a condition whose name explicitly attributes the pain to growth.

The authors concluded that there is currently no clear consensus in the medical literature about what defines growing pains, and clinicians should therefore be cautious about allowing the diagnostic label itself to dictate treatment.

Myth 1: Children's Bones Hurt Because They Are Growing

This is the traditional explanation.

Bones lengthen rapidly.

Muscles and tendons supposedly cannot “keep up.”

Tension develops.

The legs hurt.

It is an intuitively appealing story.

It is also poorly supported by evidence.

Normal longitudinal bone growth occurs primarily at the growth plates, or physes, near the ends of developing long bones.

These regions are biologically active, but physiological bone growth is not ordinarily painful.

More importantly, if growing pains really resulted from rapid skeletal growth, we should expect episodes of pain to occur preferentially during periods when children are growing fastest.

Researchers have now looked at this directly.

The Study That Directly Tested the Growth Theory

A particularly useful study was published in Scientific Reports in 2024.

Researchers followed a large cohort of Danish preschool children and examined both musculoskeletal pain and actual changes in height.

The study involved 777 children, with longitudinal growth data available for 698 after exclusions.

Researchers examined both:

absolute rapid growth, and
relative rapid growth adjusted for the child's starting height.

Neither measure was associated with growing pains.

The odds ratios were:

absolute rapid growth: OR 0.74, 95% CI 0.38–1.45
relative rapid growth: OR 0.73, 95% CI 0.37–1.43

In other words, the children going through comparatively rapid periods of growth were not more likely to experience growing pains.

The researchers concluded that their results disputed the theory that the pain is related to growth and suggested that the name itself is a misnomer.

That is one of the clearest pieces of evidence we have against the traditional explanation.

Children With Growing Pains Are Growing—but That Does Not Mean Growth Causes the Pain

This distinction sounds obvious when stated explicitly.

But it is an important lesson in causation.

Children who develop:

Sever's disease,
Osgood-Schlatter disease,
muscle fatigue,
sports injuries,
joint hypermobility,
recurrent limb pain

are also growing.

That does not mean growth itself caused those conditions.

A child being in a developmental period when growth occurs does not establish normal skeletal growth as the biological mechanism producing their symptoms.

So perhaps the first myth we should retire is:

“Their legs hurt because their bones are growing.”

We currently do not have convincing evidence that this is true.

Why, Then, Are They Called Growing Pains?

The terminology is largely historical.

Descriptions resembling growing pains date back roughly two centuries.

The term became associated with childhood development long before modern biomechanics, paediatric rheumatology, pain neuroscience and skeletal physiology were understood.

Once medical terminology becomes established, it can survive remarkably well—even after the original explanation becomes questionable.

Modern researchers have proposed terms such as:

benign nocturnal limb pains of childhood

recurrent paediatric limb pain.

These terms are admittedly less catchy.

But they also avoid claiming that we already know the cause.

If Growth Does Not Cause the Pain, What Does?

This is where the story becomes much more interesting.

There may not be one cause.

A 2026 systematic review and meta-analysis examined 37 studies involving 16,086 participants and 17 proposed risk factors.

The overall evidence points towards growing pains being a multifactorial syndrome rather than a single disease with one mechanism.

Potential contributors include:

physical activity and mechanical loading
joint hypermobility
altered pain sensitivity
bone characteristics
vitamin-D status
neurological factors
familial susceptibility
sleep disorders including restless legs syndrome

Some of these associations are stronger than others.

None currently provides a complete explanation.

Theory 1: Physical Activity and Mechanical Loading

Parents have long reported something interesting:

“It seems worse after they've been running around all day.”

That observation may have more scientific merit than the growth theory.

The 2026 systematic review and meta-analysis found that greater physical activity was associated with growing pains.

The pooled estimate suggested affected children were approximately 34% more likely to have greater physical-activity exposure:

OR 1.34; 95% CI 1.14–1.58.

That does not prove causation.

Children who are active may differ in many other ways from less active children.

But it supports a plausible hypothesis:

Some cases may represent a form of musculoskeletal load intolerance or fatigue.

Children can accumulate enormous amounts of running, jumping, climbing and sporting activity without anybody recording it as “training.”

By evening, muscles and other tissues may have absorbed thousands of loading cycles.

This may partly explain another classic feature:

the child is often comfortable during the morning but develops aching later in the day.

Rather than thinking:

“The bone grew today.”

we may sometimes be better asking:

“What did those legs do today?”

Theory 2: Pain Sensitivity May Be Different

One of the most interesting discoveries in this field comes from pain neuroscience.

Researchers have measured pressure-pain thresholds in children diagnosed with growing pains.

Children with growing pains demonstrated lower pressure-pain thresholds than healthy controls.

Importantly, this increased sensitivity was found not only in the regions where they usually experienced pain.

That suggests something broader than a local calf or bone problem.

It raises the possibility that some affected children may process painful stimuli differently.

A five-year follow-up study added to this idea.

Of the children originally studied, approximately half had stopped experiencing growing pains.

Those whose symptoms persisted continued to demonstrate lower pressure-pain thresholds.

This led researchers to propose that growing pains may, in some children, represent a generalised pain-amplification phenomenon.

This is an important distinction.

It does not mean that the child's pain is imaginary or psychological.

Pain is generated by the nervous system.

Different nervous systems can interpret the same mechanical stimulus differently.

One child may experience an evening of football as ordinary muscular fatigue.

Another may experience considerably more discomfort from a similar mechanical load.

Theory 3: Could Bone Strength Matter?

Another line of research has investigated bone characteristics.

This should not be confused with the old theory that bones hurt simply because they are lengthening.

Researchers have used quantitative ultrasound to investigate properties of the tibia in children with growing pains.

Some studies have reported lower measurements associated with bone strength in affected children.

In one longitudinal study, these measurements generally improved as children became older.

Interestingly, children whose bone ultrasound measurements remained relatively low were more likely to continue experiencing symptoms.

This has led to another hypothesis:

perhaps some children experience a mismatch between repetitive physical loading and the current mechanical capacity of the developing skeleton.

That is fundamentally different from saying:

“Their bones hurt because they are growing.”

The issue, if confirmed, would be load relative to tissue capacity, not growth itself.

The 2026 meta-analysis also reported a small difference in bone-density-related measures between children with and without growing pains.

The evidence remains insufficient to establish this as the mechanism, but it is an interesting avenue of research.

Theory 4: Vitamin D

Vitamin D is probably one of the most frequently discussed possible contributors.

There is a genuine signal in the literature—but it is easy to overstate it.

The 2026 systematic review identified multiple studies investigating vitamin-D status.

When controlled studies were pooled, children diagnosed with growing pains tended to have lower serum 25-hydroxyvitamin-D concentrations than controls.

Several observational intervention studies have also reported that pain improves after deficient children receive vitamin-D supplementation.

This sounds compelling.

But there is a methodological problem.

Many of these studies were not high-quality placebo-controlled randomised trials.

When pain improves after supplementation, we cannot automatically conclude that vitamin D caused the original symptoms.

Several possibilities exist:

vitamin-D deficiency contributed to the pain
symptoms naturally improved
activity changed
another deficiency or lifestyle factor changed simultaneously
regression to the mean occurred
treatment expectations influenced symptom reporting

Vitamin-D deficiency is also relatively common in many populations.

Therefore, a more scientifically defensible conclusion is:

Vitamin-D deficiency may be a contributing or modifiable factor in some children with recurrent musculoskeletal pain.

That is very different from claiming:

“Growing pains are caused by vitamin-D deficiency.”

They are not synonymous.

Theory 5: Joint Hypermobility

Another interesting association is generalised joint hypermobility.

Some children naturally have joints that move through a greater range than average.

Hypermobility itself is not necessarily pathological.

Many hypermobile children have no symptoms whatsoever.

But increased joint excursion can alter the muscular demands of stabilising the lower extremities during:

running
jumping
cutting
climbing
prolonged walking
sport

Some observational studies have reported substantially greater rates of hypermobility among children diagnosed with growing pains.

The 2026 systematic review identified joint hypermobility as one of the more plausible associated factors.

Again, association is not causation.

But in a child experiencing recurrent leg pain after activity, assessing joint mobility makes considerably more clinical sense than simply concluding that the child is growing.

Myth 2: Growing Pains Are Caused by Flat Feet

This is particularly important from a podiatric perspective.

A very common chain of reasoning is:

child has leg pain → child has flat feet → flat feet caused the growing pains

That conclusion is too simplistic.

Flexible pronated feet are extremely common in childhood.

Finding them in a child who also has leg pain does not establish cause and effect.

A blinded study by Evans and Scutter examined 180 children aged four to six years with and without leg pain.

The investigators objectively compared several measurements of foot posture.

Although one measurement produced a statistical difference, it was weak and not clinically predictive.

Their conclusion was important:

there was no clinically meaningful relationship between foot posture and growing pains.

So we should not tell every parent:

“Your child's flat feet are causing their growing pains.”

The evidence does not support that statement.

But What About Orthotics?

This requires nuance.

There are small studies reporting improvement in children with recurrent leg pain after foot orthoses were prescribed.

One early single-case experimental series involved eight children with pronated feet and reported improvement with in-shoe intervention.

A later study involving 20 children also reported reductions in pain frequency and severity after custom foot orthoses.

But these studies were small and had important methodological limitations.

They cannot demonstrate that pronation is the universal cause of growing pains.

They tell us something different and potentially more useful:

Some children who have been labelled as having “growing pains” may actually have mechanically mediated lower-limb pain.

If a child has:

reproducible activity-related symptoms
abnormal loading patterns
symptomatic foot mechanics
lower-limb weakness
poor movement control
fatigue-related discomfort

then modifying biomechanics may reasonably form part of treatment.

But the orthotic should be prescribed for an identified mechanical problem.

Not because the diagnosis says “growing pains.”

That is a critical difference.

Growing Pains May Not Even Be One Condition

This may ultimately be the most important insight.

Imagine 100 children all being given the diagnosis “growing pains.”

One child may have:

high sporting load.

Another may have:

hypermobility and reduced muscular endurance.

Another may have:

low vitamin D.

Another may have:

increased pain sensitivity.

Another may actually have:

restless legs syndrome.

Another may have:

a mechanical lower-limb problem.

And another may simply experience benign intermittent muscular aches without any clinically important abnormality.

They can all end up under the same label because the diagnostic criteria themselves are poorly standardised.

That is probably one reason the literature has struggled to identify one biological cause.

We may be trying to find one mechanism for a heterogeneous group of children who do not all have the same condition.

Growing Pains and Restless Legs Syndrome

Restless legs syndrome deserves particular attention because its symptoms overlap surprisingly well with traditional descriptions of growing pains.

Children with restless legs syndrome may experience:

uncomfortable sensations in the legs
symptoms becoming worse while resting
symptoms predominating during the evening or night
an urge to move the legs
improvement when walking or moving
disrupted sleep

Compare that with a child who is said to wake at night with “growing pains.”

The overlap is obvious.

A 2025 review examining 24 studies concluded that the two syndromes remain clinically distinguishable but may share biological features involving factors such as iron regulation, vitamin-D status, sleep disturbance and familial susceptibility.

The authors even raised the possibility that some childhood presentations labelled growing pains could fall within a broader neurological spectrum associated with restless legs syndrome.

This remains an evolving area of research.

But it gives clinicians a useful question to ask:

“When your legs feel uncomfortable, do you feel that you have to move them?”

If movement consistently produces relief and the child describes an irresistible urge to move, restless legs syndrome deserves consideration.

Why Iron Sometimes Enters the Discussion

Iron deficiency should not be considered a routine explanation for all childhood leg pain.

However, iron metabolism is relevant to restless legs syndrome.

Therefore, when a child's supposed “growing pains” have prominent features of:

restlessness
unpleasant crawling or pulling sensations
difficulty remaining still
evening predominance
relief through movement
significant sleep disturbance

evaluation for restless legs syndrome may be more appropriate than automatically assuming musculoskeletal growing pains.

That may change whether iron studies are clinically relevant.

Growing Pains Are Not an Inflammatory Disease

The classic syndrome is considered non-inflammatory.

There should not normally be:

persistent swelling
warmth
redness
joint effusion
restricted joint movement
prolonged morning stiffness

A child with these findings does not fit the reassuring pattern of classical growing pains.

That is particularly important when considering childhood inflammatory diseases such as juvenile idiopathic arthritis.

Myth 3: Any Leg Pain at Night Is Growing Pains

Night pain is commonly associated with the diagnosis.

But timing alone is not sufficient.

A classic reassuring presentation might look something like this:

A child plays normally throughout the day.

Several hours later they develop aching in both lower legs.

A parent massages the legs.

The pain resolves.

The child sleeps.

In the morning there is:

no pain
no limp
no stiffness
no weakness
no swelling

The child then participates normally in daily activities.

That pattern is very different from a child who repeatedly wakes with progressively worsening focal pain in precisely the same bone.

Both children have night pain.

The clinical meaning is entirely different.

When Should Parents Be Concerned?

The term growing pains should never be used simply to dismiss symptoms that do not fit the characteristic pattern.

Further assessment is appropriate when there is:

Persistent focal pain

Pain repeatedly occurring at exactly the same anatomical location deserves examination.

Progressive symptoms

Pain becoming steadily more severe or frequent should be reassessed.

Persistent limping

Classical growing pains should not cause ongoing gait disturbance.

Refusal to walk or bear weight

This deserves prompt medical evaluation.

Persistent morning pain

Especially when associated with stiffness.

Joint swelling

Swelling, warmth or restricted movement suggest another process.

Significant focal tenderness

Particularly over bone.

Fever

Especially when combined with musculoskeletal pain.

Unexplained weight loss

This should not be attributed to growing pains.

Persistent lethargy or systemic illness

The child should be medically assessed.

Neurological symptoms

Weakness, numbness, altered coordination or persistent neurological complaints require further evaluation.

Does Unilateral Pain Automatically Rule Out Growing Pains?

Historically, bilateral symptoms were considered one of the classic characteristics.

But this is another area where modern evidence has complicated the textbook description.

The 2024 Danish study found that many episodes occurred unilaterally.

The authors therefore suggested that unilateral pain should not automatically exclude the diagnosis.

That does not mean persistent one-sided pain should be ignored.

There is a big difference between:

occasional episodes that sometimes occur on one side

and

progressive focal pain occurring repeatedly in the same anatomical location.

The second presentation warrants considerably more investigation.

What Else Can Cause Leg Pain in Children?

The differential diagnosis is broad.

Most childhood leg pain is benign.

Nevertheless, depending on the age, location and symptom pattern, clinicians may need to consider:

Mechanical and sporting conditions

muscular fatigue
muscle strain
joint hypermobility
biomechanical overload
stress reaction or stress fracture
symptomatic foot mechanics

Growth-plate and traction conditions

These really are associated with the immature skeleton, but are distinct diagnoses:

Sever's disease
Osgood-Schlatter disease
other traction apophysites

These conditions should not simply be called growing pains.

Hip conditions

transient synovitis
Legg-Calvé-Perthes disease
slipped capital femoral epiphysis

Hip pathology can sometimes present as thigh or knee pain.

Inflammatory conditions

juvenile idiopathic arthritis
enthesitis-related arthritis
inflammatory muscle disease

Infection

osteomyelitis
septic arthritis

Neurological and sleep conditions

restless legs syndrome
peripheral neurological disorders

Nutritional and metabolic conditions

vitamin-D deficiency
metabolic bone disease in selected cases

Haematological or malignant disease

Rarely:

leukaemia
osteosarcoma
Ewing sarcoma
other tumours

These serious conditions are uncommon.

Their inclusion here should not frighten parents.

The point is simply that “growing pains” should be a pattern recognised after clinical assessment—not an automatic explanation applied to every painful leg.

What Should a Proper Assessment Include?

For recurrent childhood leg pain, the history is exceptionally important.

1. Where exactly is the pain?

Is it:

calf
shin
knee
thigh
heel
ankle
hip
muscle
joint
bone?

Children may need to physically point to the area rather than describe it verbally.

2. Is it one leg or both?

And if unilateral, is it always the same side?

3. When does the pain occur?

during activity?
immediately after sport?
several hours later?
before bed?
during sleep?
first thing in the morning?

Timing can dramatically change the differential diagnosis.

4. What happened that day?

Children do not necessarily think of play as exercise.

Ask about:

football
gymnastics
dance
running
playground activity
school sport
long walks
new sporting programmes

The relationship between load and symptoms can be revealing.

5. Is there morning stiffness?

This is very different from waking up completely pain-free.

6. Is the child limping?

A persistent limp does not fit classical benign growing pains.

7. Are the joints hypermobile?

Generalised hypermobility may affect muscular demands and loading.

8. How strong is the child?

Particularly examine:

calf strength
quadriceps
hamstrings
hip abductors
hip extensors
balance and lower-limb control

A mechanically overloaded child does not always need less activity.

Sometimes they require greater capacity to tolerate activity.

9. What do the feet and legs do during walking and running?

This is where gait examination becomes useful.

Foot posture alone should not be blamed.

But clinicians can assess the entire kinetic chain for:

asymmetry
movement control
abnormal loading
instability
fatigue
functional weakness

10. Does moving the legs make the symptoms better?

This may help identify restless legs syndrome.

Do Children With Growing Pains Need Blood Tests or X-Rays?

Not necessarily.

When the history is characteristic and the physical examination is completely normal, extensive investigation is generally unnecessary.

The diagnosis has traditionally been clinical.

However, investigations become appropriate when the presentation is atypical.

Depending on the findings, these may include:

radiographs
blood count
inflammatory markers
iron studies
vitamin-D testing
metabolic investigations
ultrasound
MRI

The important point is that tests should be directed by the clinical differential diagnosis, rather than ordered routinely because somebody used the term growing pains.

What Actually Helps?

The treatment literature is surprisingly thin.

This is another consequence of having a diagnostic category that is poorly defined.

If different studies are recruiting biologically different children under the same label, determining whether one treatment works becomes difficult.

Nevertheless, several approaches are reasonable.

Stretching

One of the few controlled treatment studies was published by Baxter and Dulberg in 1988.

Children were assigned either a programme involving regular stretching of the:

quadriceps
hamstrings
calf musculature

or a control approach.

The stretching group showed faster symptom improvement.

But the study was tiny—only 34 children completed the two groups—and was not blinded.

A later evidence review described it as the best available randomised evidence for treatment while simultaneously emphasising its methodological limitations.

So stretching is reasonable.

But it should not be portrayed as a scientifically proven cure.

Massage and Heat

Many parents instinctively massage the child's legs or apply warmth.

These measures can be helpful for short-term symptom relief and are generally reasonable in a child who has already been appropriately assessed.

Their effectiveness does not establish the underlying mechanism.

Strengthening May Matter Just as Much as Stretching

This is often overlooked.

If a child demonstrates:

hypermobility
poor muscular endurance
poor lower-limb control
high sporting load
repeated fatigue-related symptoms

then endlessly stretching them may not address the important problem.

They may instead benefit from improving:

calf capacity
hip strength
lower-limb control
balance
sport-specific conditioning

The correct intervention should follow the clinical findings.

Activity Modification Does Not Mean Stopping Sport

Because activity appears associated with symptoms, some children may benefit from temporary load management.

This can involve adjusting:

number of sports sessions
running or jumping volume
recovery between training days
sudden increases in activity
footwear
training surface

The objective is usually not inactivity.

Children need physical activity.

The goal is finding a level of loading that their body can tolerate while capacity develops.

Orthotics: Treat the Child, Not the Label

Foot orthoses may be appropriate when assessment identifies a relevant biomechanical indication.

For example, a child might demonstrate:

symptomatic mechanical overload
reproducible pain with activity
excessive movement associated with symptoms
fatigue
instability
a clear response to mechanical modification

In that situation, an orthotic intervention may form part of the management strategy.

But there is insufficient evidence to prescribe foot orthoses simply because a child has been diagnosed with growing pains.

Flat feet do not automatically cause growing pains.

And growing pains do not automatically require orthotics.

Vitamin D: Test and Treat When Clinically Appropriate

If vitamin-D deficiency is suspected or demonstrated, addressing it is sensible medical care.

But supplementation should not become another blanket treatment for every child experiencing recurrent leg pain.

The emerging evidence suggests an association.

It has not established vitamin-D deficiency as the universal cause.

What We Assess at Family Podiatry Centre

When children present with recurrent leg pain, our objective is not simply to decide whether the child “has growing pains.”

The more useful objective is to understand the pain.

Depending on the child's symptoms, an assessment may include:

detailed pain history
joint range of motion
hypermobility assessment
muscle strength
balance
foot posture
lower-limb alignment
walking and running gait analysis
activity and sporting load
footwear
localisation of painful structures

Where symptoms do not fit a typical benign mechanical pattern—or where red flags are present—further medical investigation or referral may be appropriate.

The aim is not to medicalise every childhood ache.

It is to avoid using growth as an explanation when another explanation may be more useful.

So Are Growing Pains a Myth?

Not exactly.

The pain is not the myth.

Children genuinely experience recurrent leg pain.

What deserves to be challenged is the assumption that the pain happens because the child is growing.

The current evidence gives us no convincing reason to believe that normal rapid growth itself explains the syndrome.

Instead, the emerging picture suggests that children placed under the growing-pains umbrella may represent a heterogeneous group involving different combinations of:

physical loading
muscular fatigue
hypermobility
pain sensitivity
skeletal loading capacity
vitamin-D status
neurological factors
sleep-related disorders
individual biomechanics

There may therefore never be one single “cause of growing pains.”

That may be because growing pains were never one single disease in the first place.

The Bottom Line

For approximately 200 years, children with unexplained leg pain have been told:

“You're growing.”

Modern research gives us good reason to reconsider that explanation.

A large 2022 review showed that there is remarkably little agreement about how growing pains should even be defined.

A 2024 longitudinal study specifically examined growth velocity and found no association between rapid growth and growing pains.

And a 2026 systematic review involving more than 16,000 participants points towards a collection of possible contributors rather than normal growth as a singular cause.

So perhaps the better conversation with a child experiencing recurrent leg pain is no longer:

“You're growing. Don't worry about it.”

It is:

“The pain is probably benign, but let's understand why your legs are hurting.”

That small change in language encourages something medicine should always value:

curiosity before assumption.

Frequently Asked Questions

Are growing pains really caused by growing?

There is currently no convincing evidence that rapid childhood growth causes growing pains. A 2024 longitudinal study specifically compared pain episodes with periods of rapid growth and found no association.

At what age do growing pains occur?

They are most commonly described in preschool and school-aged children, although published definitions vary considerably.

Where do growing pains normally hurt?

The calves, shins, thighs and region behind the knees are commonly reported.

Do growing pains occur in both legs?

Classically they have been described as bilateral, but newer evidence shows that episodes can also occur unilaterally. Persistent focal pain in the same leg still warrants assessment.

Can growing pains wake a child at night?

Yes. Evening and night pain are characteristic of the traditional syndrome. The child is usually comfortable and functioning normally again by morning.

Should a child limp with growing pains?

Persistent limping is not typical and should prompt further assessment.

Can flat feet cause growing pains?

There is no good evidence that flat-foot posture universally causes growing pains. Some individual children can nevertheless have mechanically mediated lower-limb pain associated with their movement or loading pattern.

Do orthotics treat growing pains?

Not routinely. Orthotics may be useful when a child has a specific biomechanical problem contributing to symptoms, but they should not be prescribed simply because the label “growing pains” has been applied.

Does vitamin-D deficiency cause growing pains?

Children diagnosed with growing pains have, on average, shown lower vitamin-D levels in several studies. However, current research does not establish vitamin-D deficiency as the sole or universal cause.

Should children with growing pains stop playing sport?

Usually not. Physical activity is important for children's health. Where activity clearly triggers symptoms, temporary load modification and improving physical capacity may be more appropriate than stopping sport altogether.

When should I worry about my child's leg pain?

Persistent focal pain, swelling, morning stiffness, progressive symptoms, limping, inability to bear weight, fever, unexplained weight loss or systemic illness should be medically assessed.

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Disclaimer: The word "treatment" in this article refers to the care and management of a patient’s health to prevent, cure, or improve a condition. Treatment results vary and do not necessarily indicate a cure. This article is for informational and educational purposes only and does not constitute medical advice.

About the Author

Mark B. Reyneker, BTech (Podiatry), MSc (Palaeontology) is a podiatrist and Founder & Clinical Director of Family Podiatry Centre, with more than 25 years of clinical experience across South Africa, Malaysia and Singapore. His clinical interests include foot and lower-limb pain, gait and biomechanics, sports-related foot conditions, orthotic therapy and footwear.

Alongside his clinical practice, Mark conducts research into human gait and foot biomechanics. His MSc research at the University of the Witwatersrand investigated human propulsion and the structural properties of the metatarsals. He is also the inventor of A Foot Orthotic, an orthotic technology developed through an international patent family.

References

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Evans, A.M. and Scutter, S.D. (2007). Are foot posture and functional health different in children with growing pains? Pediatrics International, 49(6), 991–996.

Evans, A.M. (2008). Growing pains: contemporary knowledge and recommended practice. Journal of Foot and Ankle Research, 1, 4.

Hashkes, P.J. et al. (2004). Decreased pain threshold in children with growing pains. Journal of Rheumatology, 31(3), 610–613.

Hestbæk, L., Lücking, A. and Jensen, S.T. (2024). Growing pains in Danish preschool children: a descriptive study. Scientific Reports, 14, 3956.

Lehman, P.J. and Carl, R.L. (2017). Growing Pains: When to Be Concerned. Sports Health, 9(2), 132–138.

Luo, T., Huang, Y., Guo, Y. and Lian, X. (2026). Risk factors associated with growth pain disorder in children: a systematic review and meta-analysis. Frontiers in Pediatrics, 14, 1806380.

O'Keeffe, M. et al. (2022). Defining Growing Pains: A Scoping Review. Pediatrics, 150(2), e2021052578.

Rosen, A.E.V. et al. (2025). Restless legs syndrome and growing pains in childhood: understanding the link. Frontiers in Neurology, 16, 1603694.

Smith, M. et al. (2025). Assessments, diagnostic criteria and outcome measures for growing pains and persistent pain in the presence of restless leg syndrome in children: a scoping review. BMJ Open.

Uziel, Y. and Hashkes, P.J. (2007). Growing pains in children. Pediatric Rheumatology, 5, 5.

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Frequently Asked Questions

They are most commonly described in preschool and school-aged children, although published definitions vary considerably.

The calves, shins, thighs and region behind the knees are commonly reported.

Classically they have been described as bilateral, but newer evidence shows that episodes can also occur unilaterally. Persistent focal pain in the same leg still warrants assessment.

Yes. Evening and night pain are characteristic of the traditional syndrome. The child is usually comfortable and functioning normally again by morning.

Persistent limping is not typical and should prompt further assessment.

Persistent focal pain, swelling, morning stiffness, progressive symptoms, limping, inability to bear weight, fever, unexplained weight loss or systemic illness should be medically assessed.