Dr. Daniel Turner, DC explains how to tell normal growing pains from an injury that needs evaluation — warning signs, growth plates, and when to get your
As a chiropractor in North Georgia, where weekend travel ball, cross country meets, and youth golf fill our calendars, this is one of the most common questions I hear from parents: "My child keeps complaining their legs hurt at night — is that just growing pains, or is something actually wrong?" It is a fair question, and an important one. Most of the time the answer is genuinely reassuring. But part of being a careful clinician is knowing the small handful of patterns that should never be brushed off as "just growing."
So let me walk you through how I think about this with my own patients — and with my own kids. My goal is to help you feel calmer about the everyday aches that come with an active, growing body, while giving you a clear, honest list of the signs that mean it is time to have your child looked at. When in doubt, get it evaluated. That is never the wrong call, and a quick visit to confirm everything is fine is always worth the peace of mind.
Yes — for many school-age kids, intermittent achy leg pain is a normal and benign part of childhood. "Growing pains" is the everyday term for a common pattern of muscle aches, usually in the legs, that tends to show up in children roughly between ages 3 and 12. Despite the name, there is no strong evidence that the pain comes from bones lengthening. More often it seems related to a long day of running, jumping, and playing in a body that is busy and active.
Here is the classic picture I describe to parents. The pain is achy or crampy rather than sharp. It shows up in both legs — typically the front of the thighs, the calves, the shins, or behind the knees — not in one isolated spot. It tends to arrive in the late afternoon or evening, sometimes waking a child from sleep, and it is reliably gone by morning. Crucially, the next day the child gets up and plays normally with no limp and no lingering soreness. A warm bath, gentle massage, and reassurance usually settle it down.
If that description matches your child, you are very likely dealing with ordinary growing pains. They can be uncomfortable in the moment, and a child crying at bedtime is no fun for anyone, but the pattern itself is not dangerous. It also helps to remember that growing pains tend to be episodic — a child might have a rough night or two, then nothing for a week or more. That on-and-off rhythm, with completely normal days in between, is one of the most reassuring features of the whole pattern.
One more thing I tell families: growing pains do not have to be "growth spurt" pains in any literal sense. You do not need to see a measurable jump in height to explain a sore evening. A particularly active afternoon — a long practice, a day at the park, a tournament weekend — is a far more reliable predictor of an achy bedtime than any change on the growth chart.
The clearest way to separate the two is to look at the location, the timing, and the trajectory of the pain. Growing pains are diffuse, symmetrical, and self-limited. An injury tends to be the opposite — focused in one place, often on one side, and either tied to a specific event or steadily getting worse rather than better.
When a parent describes pain that the child can point to with one finger, I pay attention. Benign growing aches are vague — a kid will rub a whole calf or the general area behind both knees. A true injury usually has an address. If your child consistently points to the same single spot — the outside of one knee, a particular point on the shin, one hip — that specificity is a clue worth taking seriously.
Timing is the second big clue. Growing pains favor the evening and night and vanish by daylight. An injury does not respect the clock the same way; it often hurts most with use, lingers into the morning, and is still there — sometimes worse — the next day. If your child wakes up sore, limps to the bathroom, or is still guarding a limb at breakfast, that is not the growing-pains rhythm.
Trajectory is the third. Growing pains do not have a steady upward arc. They come and go and, over months, tend to fade as a child grows. An injury, by contrast, either follows a clear event (a fall, a collision) or builds steadily — a little worse each week, gradually limiting more activity. When the overall direction of travel is "worse, not better," that alone is a reason to get checked.
Here are the patterns that move a complaint out of the "growing pains" box and into "let's have this looked at." Any one of these is reason enough to schedule an evaluation:
Notice the theme: growing pains come and go and leave no trace, while injuries persist, localize, and often visibly change the body (swelling, limp, guarding). If the aches are interfering with everyday activity once the immediate episode passes, that is not the growing-pains pattern. And if you find yourself keeping a mental tally because something does not feel right, trust that instinct — it is usually telling you something.
Parents often apologize for not having a perfect description, but a few simple observations make a real difference at an appointment. Before you come in, it helps to note where the pain is (one spot or all over, one side or both), when it happens (during activity, at rest, at night), how long it has been going on, and what changes it (better with rest, worse after the sport, eased by a warm bath). If there was a specific incident, jot down roughly when and how it happened. A short note on your phone is plenty. The clearer the story, the faster any clinician — including your pediatrician — can sort a benign ache from something that needs imaging or treatment.
This is the part I most want parents of young athletes to understand, because it is where a child's body is genuinely different from an adult's. Growing children have growth plates (physes) — areas of developing cartilage near the ends of their long bones where growth happens. These zones are softer and, in some ways, more vulnerable than the surrounding bone and the nearby ligaments. In a young athlete, a force that would simply sprain an adult's ligament can instead injure the growth plate or the spot where a tendon attaches to bone.
That is why I never wave off what looks like "just a sprain" in a child the way I might in an adult. A swollen, painful ankle or wrist in a kid after a fall warrants real evaluation, because the injury may involve the growth plate even when an X-ray initially looks unremarkable. The American Academy of Orthopaedic Surgeons has good plain-language material on how children's bones and growth plates respond to repetitive stress — worth a read for any sports parent (AAOS OrthoInfo: Overuse Injuries in Children).
The practical takeaway is not to panic over every bump and bruise — kids are resilient, and most knocks are minor. It is simply to give a child's joint injuries a slightly lower threshold for evaluation than you would an adult's. When the structure that gets hurt may be a growth plate rather than a ligament, having a professional take a look is the responsible default, especially if swelling, a limp, or point tenderness over the bone is present.
Not every real injury comes from a dramatic fall. In our area, where kids often play one sport year-round, overuse injuries are common — and they sneak up. Conditions like Osgood-Schlatter (pain at the bony bump below the kneecap) and Sever's (heel pain at the back of the foot) are growth-plate-related overuse problems, not growing pains, even though families sometimes lump them together.
The tell here is that the pain is tied to a specific location and tends to flare with activity — it hurts more during and after the sport, and the child may favor the leg. That is very different from the bilateral, after-dark, gone-by-morning rhythm of true growing pains. If your athlete has activity-related knee or heel pain that keeps coming back, our notes on shoulder and knee complaints and on the broader topic of youth sports injuries may help you frame the conversation with your child's care team. Sensible load management — adequate rest, conditioning, and not specializing in a single sport too early — is one of the best protections, and the AAOS covers this well in its Guide to Safety for Young Athletes.
Different sports tend to stress different areas, and knowing the common patterns helps you stay alert without becoming anxious. Distance runners and soccer players often feel it in the shins, knees, and heels. Throwing and overhead athletes — baseball pitchers, volleyball and tennis players — load the shoulder and elbow, where growth-plate and tendon-attachment problems can develop with too much volume. Gymnasts and young golfers put rotational and extension stress through the spine. The common thread is repetition without enough recovery. When pain shows up reliably with a particular motion or after a particular practice, treat that as a signal to back off the volume and, if it persists, to have it evaluated rather than to push through it.
A few simple habits genuinely lower the risk: honoring rest days and an off-season, varying sports across the year rather than specializing too early, easing back gradually after time off instead of jumping to full intensity, and taking complaints of recurring activity-related pain seriously the first time rather than the fifth. None of this requires special equipment — it is mostly about pacing a growing body sensibly.
My honest rule of thumb: when in doubt, get it evaluated. You will never regret having a professional confirm that everything is fine, and the rare time something needs treatment, catching it early makes a real difference. You know your child better than anyone — if your gut says something is off, that instinct is worth acting on.
For most non-urgent complaints, your child's pediatrician is an excellent first call, and for a young athlete a team physician or sports-medicine clinician is well suited to the question. The point is simply that someone qualified lays eyes and hands on the problem rather than the family guessing. Coordinating care — keeping your pediatrician in the loop about what is going on and what anyone else recommends — keeps everyone working from the same picture and is always the safest approach.
Some situations are not "wait and see" — they are urgent. Go to urgent care or the emergency department right away, before any chiropractic or routine appointment, if your child has any of the following:
I want to be especially clear about head injuries. A suspected concussion is a medical matter, full stop. If your child takes a blow to the head and you suspect a concussion, remove them from play immediately and have a physician evaluate them, following CDC HEADS UP guidance and a medical return-to-play protocol. Chiropractic care does not treat or cure concussion. At most, after a physician has evaluated and cleared your child, conservative care may help any associated neck or muscle strain — but the concussion itself belongs with your pediatrician or team physician. When in doubt about a head injury, err on the side of removing the child from play and getting medical evaluation; the cost of caution is low and the cost of missing it can be high.
For the non-emergency cases — the activity-related knee pain, the nagging back ache, the kid who is moving a little differently — a careful evaluation starts with listening and a hands-on exam. I want to know exactly where it hurts, when it started, what makes it better or worse, and whether the pattern fits a benign ache or something mechanical that I can help with. I look at how the child moves, where they are tender, and whether a joint moves normally. Sometimes the most valuable thing I do is reassure a worried family. Other times it is recognizing a complaint that needs imaging or a referral to your pediatrician or an orthopedist, and saying so plainly. No sales — only honest care.
I also try to set realistic expectations for parents. A first visit is mostly listening, examining, and explaining — not a long course of treatment decided on the spot. If something points toward a medical workup, I will say so and help you get to the right provider rather than keeping the child in my office. That hand-off is part of good care, not a failure of it.
When a problem is genuinely musculoskeletal — say, a young golfer with mechanical low back pain from repetitive rotation, or a runner with movement restrictions — conservative, evidence-based care can be a reasonable part of the plan, ideally coordinated with your child's other providers. If you want a sense of how spinal manipulation is studied and where it fits, the NIH's overview is a balanced starting point (NCCIH: Spinal Manipulation — What You Need To Know). And I always treat children more conservatively than adults, with techniques matched to a young, growing body.
When the pattern clearly fits benign growing pains, the home approach is gentle and low-tech. Reassurance matters more than parents expect — a calm voice and the knowledge that this is normal and will pass often takes the edge off a hard bedtime. A warm bath before bed, gentle massage or stretching of the sore calves and thighs, and a warm compress can all help settle an evening ache. Many children respond to simply being comforted and rubbed for a few minutes.
What I would not do is medicate a child routinely for recurring night pain without first being confident of the cause, or use any over-the-counter medicine for a child without checking dosing and appropriateness with your pediatrician or pharmacist. And if the "growing pains" stop fitting the benign pattern — they localize, bring a limp, swell, or steadily worsen — that is the moment home care ends and evaluation begins.
Growing pains are most typical in the preschool and early school years and tend to ease as children get older. That said, age is a guide, not a rule, and it should never be used to dismiss a worrying sign. A red-flag pattern — point tenderness, a limp, swelling, worsening night pain, or systemic symptoms — deserves the same careful look at any age. If the complaint does not fit the gentle, come-and-go, both-legs, gone-by-morning picture, the child's age does not make it safe to ignore.
Most childhood aches are exactly what they appear to be: the ordinary cost of a busy, active, growing body, and they pass on their own. Growing pains are real, they are common, and they are not dangerous. You can usually manage them at home with reassurance, gentle stretching and massage, and a warm bath before bed.
The job is simply to stay alert to the patterns that do not fit — pain in one specific spot, a limp, swelling, night pain that keeps getting worse, or anything that follows a real injury. Those deserve a look. If you are ever unsure which camp you are in, that uncertainty itself is a good reason to call your pediatrician or stop in. We are happy to help you sort it out and point you in the right direction, whether that is conservative care with us or a referral elsewhere. You can learn what a first visit looks like on our new patients page. When in doubt, get your child evaluated — it is the calm, responsible move, and it is always okay to ask.
Growing pains are achy, affect both legs (often calves, shins, thighs, or behind the knees), happen in the evening or at night, and are gone by morning with no limp. An injury tends to localize to one specific spot, often on one side, comes with a limp or swelling, follows a specific fall or collision, or steadily worsens over time. If the pain has an address your child can point to, persists, or changes how they move, have it evaluated by your pediatrician or a clinician.
Growing pains are most common in school-age children, roughly between ages 3 and 12. Despite the name, they are not clearly caused by bones lengthening — they more often follow a busy day of running and playing. They tend to come and go and do not interfere with normal activity once the episode passes. Age is a guide, not a rule, so any worrying or red-flag sign still deserves evaluation regardless of age.
Not always. Occasional evening or nighttime leg aches that are gone by morning, affect both legs, and leave no limp are usually benign growing pains. The concern is night pain that steadily worsens over days and weeks, wakes your child consistently, localizes to one spot, or comes with fever, weight loss, or fatigue. Those patterns are medical red flags and warrant seeing a physician promptly.
Growing children have growth plates — softer zones of developing cartilage near the ends of their long bones. They can be more vulnerable than nearby ligaments, so a force that would only sprain an adult can sometimes injure a child's growth plate. That is why a swollen, painful joint in a kid after a fall should be evaluated rather than assumed to be just a sprain, even if an initial X-ray looks normal.
No. A suspected concussion is a medical matter. Remove your child from play immediately and have a physician evaluate them, following CDC HEADS UP guidance and a medical return-to-play protocol. Chiropractic care does not treat or cure concussion. At most, after a physician has evaluated and cleared your child, conservative care may help any associated neck or muscle strain — but the concussion itself belongs with your pediatrician or team physician.
Go to urgent care or the ER right away if your child cannot bear weight or use a limb, has an obvious deformity or suspected fracture, has numbness, tingling, or weakness, has severe or escalating pain, or has any head injury — especially with confusion, drowsiness, vomiting, or a worsening headache. These are not wait-and-see situations.
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