Definition

• Pain in the legs
• Includes hip, knee, ankle and toe joints
• Includes minor muscle strain from hard work or sports (overuse)
• The pain is not caused by an injury

Health Information

Causes

• Main Causes. Muscle spasms (cramps) and strained muscles (overuse) account for most leg pain.
• Muscle Cramps. Brief pains (1 to 15 minutes) are often due to muscle spasms (cramps). Foot or calf muscles are especially prone to cramps that occur during sports. Foot or leg cramps may also awaken your child from sleep. Muscle cramps that occur during hard work or sports are called heat cramps. They often respond to extra fluids and salt.
• Muscle Overuse (Strained Muscles). Constant leg pains are often from hard work or sports. Examples are running or jumping too much. This type of pain can last several hours or up to 7 days. Muscle pain can also be from a forgotten injury that occurred the day before.
• Growing Pains. 10% of healthy children have harmless leg pains that come and go. These are often called growing pains (although they have nothing to do with growth). Growing pains usually occur in the calf or thigh muscles. They usually occur on both sides, not one side. They occur late in the day. Most likely, they are due to running or playing hard. They usually last 10 to 30 minutes.
• Calcium Deficiency. Calcium and Vitamin D deficiency can cause low grade bone pains. Pain is mainly in the legs and ribs. Children on a milk free diet are at risk.
• Viral Infections. Muscle aches in both legs are common with viral illness, especially influenza.
• Serious Causes. Fractures, deep vein thrombosis, neuritis (nerve infection) and arthritis (joint infection). Septic arthritis (a bacterial infection of any joint space) is a medical emergency. The symptoms are severe joint pain, joint stiffness and a high fever. Toxic synovitis of the hip is a harmless condition. It can imitate a septic arthritis of the hip. The symptoms are a limp, moderate pain and usually no fever. Toxic synovitis tends to occur in toddlers after jumping too much.

Pain Scale

• Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: The pain is very bad. It keeps your child from doing all normal activities.

Care Advice

1. Overview:
   • Muscle cramps are common and easy to recognize.
   • Strained muscles are a common cause of unexplained leg pains.
   • Examples of triggers are hiking, running or any hard sports.
   • Weekend warriors who are out of shape get the most muscle pains.
   • Here is some care advice that should help.
2. Treatment For Muscle Cramps:
   • Muscle cramps in the feet or calf muscles occur in a third of children.
   • Stretching. During attacks, stretch the painful muscle by pulling the foot and toes upward. Stretch as far as they will go to break the spasm. Stretch in the opposite direction to how it is being pulled by the cramp.
   • Cold Pack. Use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the sore muscle for 20 minutes.
   • Water. Heat cramps can occur with hard sports on a hot day. If you suspect heat cramps, have your child drink lots of fluids. Water or sports drinks are good choices. Continue with stretching and using a cold pack.
   • Prevention. Future attacks may be prevented by daily stretching exercises of the heel cords. Stand with the knees straight. Then, stretch the ankles by leaning forward against a wall. Place a pillow under the covers at the foot of the bed at night. This gives the feet more room to move at night. Also, be sure your child gets enough calcium in the diet. Daily Vitamin D3 may also help.
3. Treatment For Strained Muscles From Overuse:
   • Pain Medicine. To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
   • Cold Pack. For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the sore muscles for 20 minutes. Repeat 4 times on the first day, then as needed. Caution: Avoid frostbite.
   • Heat Pack: If pain lasts over 2 days, put heat on the sore muscle. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, then as needed. Caution: Avoid burns. For stiffness all over, use a hot bath instead. Move the sore leg muscles under the warm water.
4. Treatment for Growing Pains:
   • Most often, the pains are mild and don’t last long. No treatment is needed.
   • Massage. Rub the sore muscles to help the pain go away.
   • Pain Medicine. If the pain lasts more than 30 minutes, give a pain medicine. You can use either acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
   • Prevention. Research has shown that daily stretching can prevent most growing pains. Stretch the quads, hamstrings and calf muscles. Also, be sure your child gets enough calcium and Vitamin D in their diet.
5. What to Expect:
   • Muscle cramps usually last 5 to 30 minutes.
   • Once they go away, the muscle returns to normal quickly.
   • A strained muscle hurts for 3 to 7 days. The pain often peaks on day 2.
   • Following severe overuse, the pain may last a week.

Call Your Doctor If

• Muscle cramps occur often
• Fever, limp, or a swollen joint occurs
• Pain caused by work or sports lasts more than 7 days
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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