December 2015 Bulletin

Growing Pains in Children and Adolescents: A Q&A With Dr. Suzanne Yandow

Yandow Bulletin

Dr. Suzanne Yandow, chief of Orthopedics and Sports Medicine at Seattle Children’s, addresses questions about growing pains in children and adolescents. Thank you to Dr. Wendy Sue Swanson, a pediatrician at The Everett Clinic in Mill Creek, a member of Seattle Children’s medical staff and executive director of Digital Health, and author of the Seattle Mama Doc blog, for submitting these questions.

Are there new updates or insights as to who gets growing pains?

No. They’re not well understood scientifically. The belief of what causes growing pains is that bone grows first, which then stimulates the growth of muscle and soft tissue. It’s during this period of rapid skeletal growth that the muscles and tendons lag behind the bone growth, causing a discomfort for kids because of the increased stretch and pressure.

Why do they occur in boys more than girls?

The reason you hear more about growing pains in boys than girls is because there’s an extended period of growth. Boys’ growth plates tend to close about two years later than girls.

Why, physiologically, are growing pains more common at the end of preschool and during the early years (ages 4 to 8)? What happens in a child’s rate of growth to trigger a pain response?

Growing pains are timed with periods of rapid growth in those early years and usually again in adolescence. It’s during these times that children feel more discomfort from growing pains. (Learn more.)

What steps can pediatricians take in the office before referring for more care?

It’s important to really characterize the pain by determining the location of the pain, when it occurs, what makes it better and what makes it worse. You also want to get a family history to check for a genetic tie to conditions affecting their musculoskeletal system, like arthritis.

Growing pains often occur in the evenings and on days when a child has been particularly active. They usually occur in both legs around the knees, calves and shins, and do not usually wake the child from a sound sleep. Typically, rubbing the legs or using a warm towel relaxes the muscles and makes them feel better.

If you think it may be something other than growing pains and you have access to diagnostic tests and lab results with quick turnaround times, you may want to get a complete blood count (CBC) with differential to see the patient’s platelet, hemoglobin and white blood cell counts.

If you push on a specific spot and it hurts, order an X-ray to see the bone. It’s also important to see if there is a mass or if there is swelling, redness or limitations in the range of motion in the joint. These can all be signs of other conditions. By the time you consider ordering magnetic resonance imaging (MRI) or other studies, you want to know specifically what you are looking for.

For primary care providers who are unsure what to do or do not have access to diagnostic tests, you can call Seattle Children’s at 206-987-2109, choose option 7 and speak to a specialist to determine if it is an urgent or emergent problem. It’s always good to take care of a child close to their home by their primary care provider, but if it’s something more subspecialized, we are happy to help.

What are the regular red flags that demand lab and/or diagnostic tests?

Pain that wakes a child up at night is worrisome because it is frequently associated with malignant tumors. Signs of medical problems that should get your attention include a child having nighttime pain that wakes them up, specifically if it is in one leg or in the thighs, feet or arms, or if they limp or have pain when playing sports or running.

In your experience, do kids ever limp as a result of growing pains?

If a child is limping, it is typically something other than growing pains. Growing pains may cause a child to say they have discomfort, but it doesn’t cause them to be unable to walk normally. When a child is limping, there’s more to the story.

If you have a child with a limp and an ultrasound shows fluid in the hip, they may have a septic hip or toxic synovitis. Toxic synovitis is a self-limiting process, but if a septic hip gets missed, it will destroy the femoral head, causing profound limb length inequality, and can kill a child. My recommendation is to get that child as quickly as possible to a pediatric orthopedic surgeon.

How long is too long to have growing pains?

It’s pretty characteristic with growing pains to have the discomfort for a night or two, but some kids may experience several weeks of discomfort.

What online resources can you recommend for families about growing pains?

The Pediatric Orthopaedic Society of North America has helpful information on its website for parents and physicians. Also, there’s a great book called The Practice of Pediatric Orthopedics by Dr. Lynn Staheli, former chair of Orthopedics and Sports Medicine at Seattle Children’s.

Upcoming CME for December 2015 and PALS Course Information

Everett CME: “Tetralogy of Fallot”

  • Presented by Josh Weldin, MD
  • Tuesday, Dec. 8, from 6:30 to 7:30 p.m.
  • Location: Snohomish County PUD Training Center, 2320 California Ave., Everett, WA
  • Free Category 2 CME credit
  • Light dinner will be served.
  • RSVP to Emily Rice by email or call 206-422-5668.

Bellevue CME: “Reconstructive Pelvic Medicine: Anomalies and Disorders”

  • Presented by Jeffrey Avansino, MD, pediatric surgeon, and Lusine Ambartsumyan, MD, pediatric gastroenterologist
  • Thursday, Dec. 17, from 6 to 7 p.m.
  • Location: Seattle Children’s Bellevue Clinic and Surgery Center, 1500 116th Ave. NE, Bellevue, WA – Conference Room 2207
  • Free category 2 CME credit
  • Light refreshments will be served.
  • RSVP to Melissa Christiansen by email or call 206-987-5262.

Pediatric Advanced Life Support (PALS) Courses at Seattle Children’s

2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care, published in the journal Circulation, are being integrated into Seattle Children’s Pediatric Advanced Life Support (PALS) courses.

  • Providers new to PALS can register for the Saturday, March 5, PALS course for physicians and advanced practitioners.
  • Renewing PALS providers can register for Thursday or Saturday HeartCode part 1 (online) and part 2 (classroom) PALS courses in January, March and April.

Visit for details on course profiles, dates, category 1 CME hours and registration. Questions? Email Outreach Education.

Grand Rounds for January 2016 (CME Credit Available)

Upcoming Grand Rounds

  • Jan. 7: G-Tubes and You: Implementing Standard Work and Improving Outcomes
  • Jan. 14: Addressing Inequities in the Healthcare System
  • Jan. 21: Evolution of Work on Error Disclosure: Unexpected Events in the Delivery Room
  • Jan. 28: Do Physicians Exert Undue Influence When Recruiting for Clinical Trials in the NICU?
  • See all upcoming grand rounds.

Watch Past Grand Rounds Online

  • Translating Rare Disorder and Genomic Research into Clinical Practice
  • Pain and Health Outcomes After Surgery
  • So You Want to Do Global Health? What Does That Mean; What Might That Look Like?
  • Everything You Wanted to Know About the Medical Quality Assurance Commission But Were Afraid to Ask
  • Errors in Medical Decision-Making: Is It the System or the Thinking That We Need to Attack?
  • Dramatic Healing: How Dramatic Play and Storytelling Can Play a Part in Achieving Overall Health
  • See all online grand rounds.

For Provider Grand Rounds information, visit our website.

New Medical Staff and Allied Health Professionals for December 2015

Medical Staff

  • Mark Barr, MD, Skagit Pediatrics, LLP, Pediatrics
  • Frances Chalmers, MD, Skagit Pediatrics, LLP, Pediatrics
  • Maria Huang, MD, Olympia Pediatrics, PLLC, Pediatrics
  • Richard Levine, MD, Skagit Pediatrics, LLP, Pediatrics
  • Andrea Lowe, MD, PhD, Skagit Pediatrics, LLP, Pediatrics
  • Anh-Vu Ngo, MD, Seattle Children's, Radiology
  • Navin Pinto, MD, Seattle Children's, Hematology-Oncology
  • Salaam Sallaam, MD, Seattle Children's Tri-Cities Clinic, Cardiology
  • Annika Sutton-Wolf, MD, Allegro Pediatrics – Bellevue, Pediatrics
  • Lisa Winterroth, MD, Northwest Asthma and Allergy Center, PS, Allergy
  • Cheryl Zentner, MD, Skagit Pediatrics, LLP, Pediatrics

Allied Health Professionals

  • Emily Bianconi, ARNP, Skagit Pediatrics, LLP, Pediatrics
  • Mariel Colella, ARNP, Seattle Children's, Emergency Medicine
  • Holly Henson, ARNP, Skagit Pediatrics, LLP, Pediatrics
  • Todd Ouellette, ARNP, Skagit Pediatrics, LLP, Pediatrics