Growing pains are often used casually to describe common aches or discomfort a child experiences during periods of rapid development. This benign, self-limiting pain is typically associated with the legs and lower limbs. The question of whether this classification extends to the back or spine requires careful investigation. While true growing pains are harmless, back pain in children and adolescents warrants a more cautious approach from medical professionals.
Defining the Phenomenon of Growing Pains
True growing pains are a specific, non-inflammatory musculoskeletal condition usually affecting children between the ages of three and twelve. The pain is characteristically felt deep in the muscles of the lower extremities, most commonly in the shins, calves, thighs, and behind the knees. A defining feature is the timing of the discomfort, which typically occurs late in the afternoon, evening, or may even wake a child from sleep.
The pain is often described as cramping or aching and is almost always bilateral. A physical examination will reveal no signs of inflammation, such as swelling, redness, or warmth, and the pain is gone by the following morning. The discomfort is often relieved by gentle massage or a mild pain reliever. The exact cause remains unknown, but it is not caused by actual bone growth, despite the common name.
Addressing Back Pain as a “Growing Pain”
The consensus is that true growing pains are rarely diagnosed in the spine or back region. Back pain in children and adolescents is less common than limb pain and is not classified as idiopathic or benign in the same way that classic growing pains are. Pain localized to the back, especially if persistent, raises suspicion for an underlying cause that requires specific attention.
The spine is a complex structure, making the dismissal of back pain as a simple “growing pain” inappropriate. Unlike the intermittent, bilateral nature of classic growing pains, back discomfort is often a red flag that necessitates a medical evaluation to rule out structural or pathological issues. The younger the child, particularly under the age of five, the higher the likelihood of identifying a rare, morphologic cause for the pain.
Specific Structural and Muscular Causes of Pediatric Back Pain
Musculoskeletal strain is the most common cause of back pain in children and adolescents. This pain is typically the result of injury, overuse, or poor conditioning, such as muscle strains and ligament sprains from sports or carrying a heavy backpack. Tight hamstring muscles and weak abdominal muscles contribute significantly to poor posture and can lead to persistent low back pain in teenagers.
Structural causes involve the alignment and integrity of the spine. Scheuermann’s Kyphosis is a condition seen in adolescents that causes an exaggerated forward curvature of the upper back (thoracic spine). This occurs because the vertebrae grow at different rates, becoming wedge-shaped, and the resulting pain can worsen with activity.
Another common issue is Spondylolysis, which is a stress fracture in a specific part of the vertebra. This can progress to Spondylolisthesis, where the fractured vertebra slips forward onto the bone below it. Scoliosis, a sideways curvature of the spine, is often painless but can be associated with back pain, sometimes indicating a need to investigate for other underlying issues.
Disc problems, such as a herniated disc, are less frequent in children than in adults but can occur, presenting with back and sometimes radiating leg pain. Infections of the spinal bone or discs (diskitis) and tumors, while rare, must be considered because they often present with back pain.
Warning Signs Requiring Medical Evaluation
Certain symptoms accompanying back pain should prompt an evaluation by a physician, as they suggest a potentially more serious underlying condition. Pain that occurs at night and is severe enough to wake the child from sleep is a concerning sign, as is pain that is constant and does not resolve after several weeks.
Systemic symptoms, such as an unexplained fever, chills, fatigue, or unintended weight loss, are red flags. Any complaint of weakness, numbness, or pain that radiates down into the legs suggests potential nerve involvement and requires prompt assessment. A child under the age of five with back pain, or any sign of bowel or bladder control changes, warrants immediate medical attention.