The Problem with “Growing Pains” as a Diagnosis
In 2021, six year old Eden Smith was diagnosed with growing pains in her legs. Only when her health began declining overall did doctors look more intensely at her symptoms by taking scans. Only then did they diagnose Eden Smith with stage four neuroblastoma, a cancer with a 50% chance of survival due to the aggressive nature of the disease. Growing pains, a term coined in 1823 by Marcel Duchamp, is used to describe the pain children felt in their limbs from growth during childhood. However, research has been unable to prove this traditional definition of growing pains as a true diagnosis. Even with the increasing awareness of the complexity of “growing pains,” providers are still diagnosing pediatric patients with the condition and failing to explain further implications. The child and parents are not being told that “growing pains” is simply a broad, all-encompassing term that was coined and never changed. Researchers from the University of Sydney have found that up to one-third of children may be diagnosed with growing pains, yet there is no consensus on its definition, etiology, or diagnostic criteria. This ambiguity raises ethical concerns about how pediatric pain is assessed, communicated, and treated.
These historically accepted growing pains have been revisited with new research findings and holistic approaches to medical care. For example, common links between growing pains and autoimmune diseases have come to light. These disorders such as Juvenile Idiopathic Arthritis (JIA) and Inflammatory Bowel Disease (IBD) can present with symptoms that are common to a growing pain diagnosis. JIA is the most common type of arthritis in children under sixteen characterized by joint inflammation, causing pain, swelling, and stiffness, from the immune system attacking the joint lining. Because symptoms can be intermittent and lack visible inflammation, JIA is frequently misattributed to growing pains, delaying treatment and risking joint damage and growth disturbances. IBD, including Crohn’s disease and ulcerative colitis, affects the gastrointestinal tract presenting extraintestinal symptoms such as joint pain, arthritis, and enthesitis (inflammation at tendon-bone junctions). These symptoms can precede digestive issues which makes for a challenging diagnosis. When joint pain is mistaken for growing pains, the underlying IBD may go undetected, leading to worsening inflammation and complications. Connective tissue disorders like Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders (HSD) can also manifest as chronic musculoskeletal pain due to joint instability. EDS is a group of genetic connective tissue disorders characterized by joint hypermobility, frequent dislocations, chronic pain, and soft, stretchy skin. Because the joints of children with EDS appear normal and pain is chronic and invisible, their symptoms are often misdiagnosed as growing pains. Without proper recognition, these children may have a delay in interventions such as physical therapy and pain management accessible with a proper diagnosis.
Beyond clinical consequences, misdiagnosis can invalidate a child’s experience of pain and leave them more likely to dismiss symptoms that indicate underlying disease, especially in cases where pain is episodic or lacking visible inflammation. Studies quantify the occurrence of this unfortunate misdiagnosis, which often leads to the true condition being identified much later and further into the disease progression. Specifically, in patients with rheumatic disease, “as [many] as 25% of patients [...] remain undiagnosed during 5 to 10 years of follow-up.” Many children, and patients in general, experience symptoms for longer than necessary before receiving proper treatment and carry life-long consequences with the progression of the untreated disease. This pattern highlights the importance of approaching pediatric pain with a more nuanced and investigative approach, regardless of diagnosis. Doctors are held to an ethical code to share with their patients (and parents in the case of minors) the true meaning of growing pains: that the pain is acknowledged but the cause is unknown and may be for a while.
A diagnosis of growing pains is typically one of exclusion, meaning it is applied after creating a list of potential diseases that are applicable to the patient’s symptoms and ruling out each option individually, usually without running pathological tests or very few. This means there is no definitive test for growing pains, but more so a bucket to place unidentifiable joint and muscle pain in children, as noted by Akron Children’s Hospital. This approach is heavily influenced by clinical bias where a physician may prematurely settle on a diagnosis based on initial impressions. A case series published in MDPI by experts at the Mayo Clinic and St. Olaf College illustrates how such biases can delay the recognition of serious conditions like celiac disease or compartment syndrome, which were initially dismissed as growing pains. Moreover, by assuming that children’s pain is exaggerated, behavioral, or even unrepresentative of the standard understanding of pain (scale of 1-10, the worst pain felt as a child compared to later in life) can further discourage a thorough evaluation. These systemic and cognitive challenges underscore the importance of a more rigorous and empathetic approach to pediatric pain assessment.
Between Dismissal and Overmedicalization:
Toward Ethical and Evidence-Based Pediatric Pain Care
At the heart of the matter lies a critical ethical tension: the risk of dismissing legitimate pain versus the danger of over medicalizing benign symptoms. Both sides present serious issues: labeling unexplained pain as “growing pains” without thorough investigation can lead to missed diagnoses of serious conditions; and yet, excessive testing and premature labeling may cause undue anxiety and unnecessary medical procedures or interventions. The continued use of “growing pains” as a catch-all diagnosis for pediatric limb pain is ethically and clinically problematic in that it risks dismissing serious conditions, delays appropriate treatment, and invalidates children’s experiences. Many pediatric nurses are “integrating empathy-driven care with technological innovation” to better care for their patients and the American Academy of Pediatrics has released new guidelines that aim “to ensure equitable treatment of pain in young people, addressing disparities” in all facets. Part of this movement to ensure equitable treatment of pain requires that providers be transparent and acknowledge uncertainty while committing to thorough evaluations. As seen in Current Emergency and Hospital Medicine Reports, a specific study has noticed that through the integration of “pharmacological and non-pharmacological interventions, technological advancements, and psychological support, healthcare providers can enhance the quality of care for pediatric patients.” Pediatric pain care is evolving and the balance between vigilance and restraint will define the future of ethical care.Experts like Dr. Laura Simons at Stanford highlights that chronic pain in children is more common than previously believed and can lead to lifelong consequences if untreated. Organizations such as the ASA are moving towards having board-certified pediatric pain specialists lead care teams, recognizing the unique needs of children in pain management. Furthermore, innovations in pain assessment are helping clinicians better understand and respond to pediatric pain experiences. Pain assessment innovations include biomarkers which are being developed to objectively measure pain and inflammation that are not visible through traditional exams. The integration of biomarkers into clinical practice allows for earlier detection of any underlying conditions. The innovations not only enhance diagnostic accuracy but also promote empathetic, child-centered care. By combining technology with developmental sensitivity and family engagement, pediatricians can better validate children’s pain experiences and avoid using the term “growing pains” when a more accurate diagnosis is within reach. As such, the future of pediatric pain diagnoses and care lies in the balance between thorough investigation and clinical discernment where, overall, the shift toward precision medicine and compassion marks a critical shift in pediatric pain care.