RECURRENT NOCTURNAL LIMB PAINS
These are also called "growing pains" or "idiopathic"
(of unknown cause) limb pains. They are remarkably common in children usually
in the primary school age group. Symptoms The history is very characteristic.
After an active day the child goes off to sleep normally but wakes after
some hours with pain in the legs usually localised chiefly to the shins
but sometimes more centred on the knees or ankles. Much less commonly there
may be some pain in in the arms as well.
Cause
This remains a mystery. It is not clear from where the pain truly arises
or what causes it. Investigations The characteristic history and the complete
lack of clinical findings are so typical that the diagnosis can usually
be made confidently without subjecting the child to any uncomfortable tests.
If there is any doubt at all, more serious arthritic and other conditions
can readily be excluded with some simple blood tests and possibly an X-ray
of the painful areas.
Treatment
It is important for the child and all others concerned, including for
instance grandparents, to understand that although the pains may be quite
severe and distressing they are benign and will go away in time. When the
pain occurs most children find local warmth and massage of the affected
limbs soothing and that may be all that is needed. If the pattern is for
the pain to persist more than a few minutes it is wise to give a dose of
paracetamol as soon as the pain occurs, this usually brings relief in about
15 minutes. Few children get the pains repeatedly on consecutive nights
so long term treatment is seldom apprpriate. However, parents do learn
the pattern of the pain in their child and can sometimes predict which
nights the child is likely to get pain. If that is the case it may be worth
giving a dose of a pain relieving medicine at bedtime. Paracetamol suspension
is usually tried first and can be effective but it has a rather short duration
of action, about four hours, so may not prevent the pain. A drug with a
longer action such as ibuprofen suspension (Junifen) may be more effective.
Sugar free preparations are available over the counter at any chemist.
Paracetamol paediatric oral suspension 120mg/5ml - single dose for children
1-5 years is 120-240mg (5-10ml), 6-12years 240-480mg (10-15ml). Junifen
suspension 100mg/5ml - single dose for children 1-2years 50mg (2.5ml),
3-7years 100mg (5ml) , 8-12years (10ml).
Outlook
Growing pains virtually never evolve into any serious form of arthritis
or other disease. They remain troublesome for a while and then disappear
as mysteriously as they came. |
