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My young son wakes crying with pains in his feet and legs. Why?

The question: My 2.5 year old son has been waking up in the middle of the night crying with pains in his feet and legs. He's losing up to an hour of sleep at night. What's causing the pain and should I see the doctor about this?

The answer: The most likely cause of these symptoms would be a phenomenon that we call "growing pains." Growing pains are extremely common, probably occurring in almost half of all children. The term is somewhat misleading, as there is no evidence to suggest that the pain is caused by growing bones or a rapid growth spurt. Growing pains can occur at any age, but are common in the late preschool age group (3 to 5 years old) that your son is about to enter. Classically, the pains occur in the evening around bedtime, but can also awaken children in the night, especially in the first few hours of sleep.

Although the pain can be experienced in any limb, the legs are most often affected. In my experience children frequently complain of discomfort in the shins, calves and thighs. The pains might be in one location one night, and another location the next.

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Warning signs that this may not be growing pains include pain that occurs in the same spot every night, evidence of swelling or redness of a limb or joint, and symptoms that are present when the child wakes up, including limping or refusing to walk. If any of these signs are present, a medical evaluation is strongly recommended.

Fortunately x-rays and blood tests are almost never needed to diagnose growing pains. There is no one treatment for growing pains that works for all children so a trial and error approach is needed. Parents can experiment with simple home remedies like hot water bottles, ice packs and massage to see what works best for their child. More severe pains may require the occasional dose of acetaminophen or ibuprofen. If none of these simple treatments is helpful or if the pain persists or worsens, then see your child's doctor.

Send pediatrician Michael Dickinson your questions at pediatrician@globeandmail.com. He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail website. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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