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A. Evaluation by system:
6. Orthopedics |
Growing Pains - Commonly Asked QuestionsIntroduction: Many parents and grandparents will call pains in children “growing pains” when they really represent serious conditions. However, this diagnosis is a reasonable one to make, but should be made carefully. What are the Ages Affected? 2-8 years with peak incidence of 5-7 years of age. How frequently does a pediatrician deal with limb pain? A common chief complaint - up to 7% of office visits in one study. (Ped Clinics N Am 1984;311053-81). This seems high - others have found it to consist of about 1% of chief complaints. Where does pain occur? The typical story is of a child complaining of sudden pain in both legs - more anterior thigh than elsewhere. It can be severe and associated with headaches or stomach aches. When does pain occur? Most typically in the evening or even awakens children from sleep. Not usually a daytime symptom. Pain can be intense and unremitting. What is found on physical examination? Normal exam. Often find children who are thin and quite active. Key question to ask at night when get a phone call from a frightened parent: Is there any redness or swelling around the knee? What is the cause of growing pains? Some think this is due to muscle fatigue with cramping. No clear cut proven etiology, but often seen after active days in thin children. What is the differential diagnosis? Vast. This is a diagnosis of exclusion; if the physical exam is normal, then usually a clearcut diagnosis. Must distinguish from overuse injury, lax ligament syndrome (associated with delayed motor milestones), conversion reaction,and, of course, all the rheumatologic diseases or arthritic diseases, hematologic diseases What should the diagnostic workup be? No tests usually indicated. Study showed that family physicians more likely to order CBC and ESR “to reassure parents” than pediatricians or pediatric orthopedists. (Archives Peds & Ad Med 1996;150:1072-6). Each doctor will have to decide whether they are doing the tests for themselves, the parents or the child. What is the treatment? Warm bath, anti-inflammatory, reassurance. Some try muscle stretching exercises based on fatigue theory. (Journal of Ped Orthopedics 1988;8:402-6). This study found that muscle stretching was better than control. If do nothing, it goes away anyway. |
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© Medical College of Georgia |
Department of Pediatrics |
Medical College of Georgia February 27, 2004 |