When a Diagnosis of ŒGrowing Pains¹ Masks Arthritis in Children

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When a Diagnosis of ŒGrowing Pains¹ Masks Arthritis in Children

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How do you know whether ³growing pains² might actually be an early sign of

arthritis or another rheumatic disease? Nearly 300,000 children in the U.S.

suffer from rheumatic diseases such as juvenile arthritis, fibromyalgia,

chronic fatigue, systemic lupus erythematosus, scleroderma or Kawasaki

disease.

Your son or daughter¹s sharp leg pains in the middle of the night can

frighten child and parent alike, raising the question about whether the

child should go to school in the morning, or go to the doctor. Most often

the pains are gone in the morning and, if called, the physician will tell

you it was ³just growing pains.²

But what if the pain is not gone in the morning or a parent is not sure they

are just routine ³growing pains?² How do you know whether ³growing pains²

might actually be an early sign of arthritis or another rheumatic disease?

³Nearly 300,000 children in the U.S. suffer from rheumatic diseases such as

juvenile arthritis (JRA), fibromyalgia, chronic fatigue, systemic lupus

erythematosus, scleroderma or Kawasaki disease,² said J.A. Lehman,

MD, Chief, Division of Pediatric Rheumatology for the Hospital of Special

Surgery in New York City.

³Children do have growing pains; in fact, they are fairly common. But

unfortunately, many children with serious problems are misdiagnosed with

growing pains for weeks or even months,² Dr. Lehman added. ³Children with

arthritis often walk abnormally after waking up in the morning, but since

they appear to get better in a few minutes, no one is very concerned.²

According to Dr. Lehman, parents need to know that:

€ Growing pains never occur during the daytime.

€ No matter how severe the pain at night, children with growing pains are

always fine the next morning.

€ Any child who wakes up in the morning with pain or experiences pain during

the day requires a careful medical evaluation.

Dr. Lehman says growing pains typically occur in young children between the

ages of three and eight years. The child will wake up suddenly from a deep

sleep complaining that his or her legs hurt. Typically, parents become aware

of the problem because the child is crying in bed. Most often the episode

occurs a few hours after the child has gone to sleep, but it can occur in

the middle of the night. Often the child will point to the front or back of

the knee or the muscles just above the knee. The pain will usually disappear

with 10-15 minutes of gentle massage and be completely gone in the morning.

If the pain goes away and the child is fine in the morning, a trip to the

doctor is not usually necessary, but any child with persistent pain or pain

during the day should be medically evaluated.

When you take your child to the doctor because you are concerned about their

pain, doctors need to know:

€ What is the quality of the problem: is it a sharp pain or a dull ache?

€ What is the exact location of the problem?

€ How long has the pain been going on and how did it start?

€ Is it getting better over time, or worse?

€ What lessens the pain, what makes it worse?

€ Is the pain in the joint (where the bones come together) above or below

the joint?

€ Is the child in pain without being touched, or does it hurt only if you

squeeze the area?

€ Is it one joint that hurts or several?

€ Is the area hot or warm to the touch?

€ Is it red or obviously swollen?

€ Does the child have other symptoms such as a rash, bumps, etc?

³Proper evaluation consists of taking a careful history and doing a complete

physical exam. In the hands of an experienced physician, this is often

sufficient to establish diagnosis. Further testing may be ordered only to

confirm the diagnosis and assure that there is nothing else wrong,² said Dr.

Lehman.

Dr. Lehman, author of It¹s Not Just Growing Pains, published by Oxford

University Press, is also professor of clinical pediatrics at Weill Medical

College of Cornell University.

For more information on helping children with Musculoskeletal Disease,

contact the National Institute of Arthritis and Musculoskeletal and Skin

Diseases at www.niams.nih.gov; The Food and Drug Administration at

http://www.fda.gov; The American Academy of Pediatrics at

http://www.aap.org; The American College of Rheumatogy at

http://www.rheumatology.org/index.asp and the American Academy of Orthopedic

Surgeons at http://www.orthoinfo.aaos.org. Dr. Lehman provides more

information about the childhood rheumatic diseases at

http://www.goldscout.com

About HSS

Founded in 1863, the Hospital for Special Surgery is a world leader in

orthopedics, rheumatology and rehabilitation. Ranked No. 1 in the Northeast

in its specialties by U.S. News and World Report, HSS was awarded Magnet

Recognition for Excellence in Nursing Service from the American Nurses

Credentialing Center. A member of the New York-Presbyterian Healthcare

System and an affiliate of Weill Medical College of Cornell University, HSS

provides orthopedic and rheumatologic patient care at New York-Presbyterian

Hospital at New York Weill Cornell Medical Center. All HSS medical staff are

on the faculty of Weill Medical College of Cornell University. Its Research

Institute is internationally recognized as a leader in the investigation of

musculoskeletal and autoimmune diseases. The hospital is located in New York

City, www.hss.edu.