Rheumatology Book


Benign Nocturnal Limb Pains of Childhood

Aka: Benign Nocturnal Limb Pains of Childhood, Growing Pains
  1. Epidemiology
    1. Prevalence: 35% of children 4-6 years old
  2. Symptoms
    1. Characteristics
      1. Deep cramping pain
      2. Pain severe enough to wake child from sleep
    2. Region
      1. Often involves lower limbs (thigh, shin, calf)
      2. Bilateral
    3. Timing
      1. Intermittent
      2. Night pain
        1. Usually resolves completely by morning
    4. Provocative
      1. Heavy Exercise during the day
    5. Palliative
      1. Heat
      2. Massage
      3. Physiotherapy
  3. Signs
    1. Pediatric Limp suggests other diagnosis
  4. Differential Diagnosis
    1. See Musculoskeletal Pain in Children
  5. Associated conditions
    1. Chronic Headaches
    2. Chronic Abdominal Pain
    3. Family History of Chronic Pain
    4. Emotional or psychological issues
  6. Management
    1. Primum non nocere (First do no harm!)
    2. Explain the condition in simple terms to the child
    3. Hot packs, massage, or warm baths
    4. Mild Analgesics and antiinflammatory medications
    5. Anticipatory guidance that pain will resolve over time
    6. Maintain Exercise program that does not exacerbate pain

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