"Growing Pains": A Critical Review of the Literature

Article type
Evans A, Scutter S
Background: Much has been written about the entity "growing pains" with many reports having appeared in the medical literature since Duchamp's first paper in 1823. The uncertainty of the aetiology of "growing pains" continues to divide approaches to management of children with this condition. Theories have been espoused, definitions attempted and treatments proposed. However, there is a vast difference in the merit of the literature with respect to the research hierarchy of evidence. The aim of this poster is to present the examined literature pertaining to "growing pains" and assessment of the same with respect to the evidence it provides.

Discussion: The notion of a hierarchy of evidence is often implied but rarely specifically stated. Sackett's levels of evidence were applied to the literature on "growing pains" to judge the conclusions for the management of patients. Sackett (1986) grades articles accordingly: 1) randomised trial with low rate of false-positive and low rate of false-negative errors, 2) randomised trial with high rate of false-positive and high rate of false-negative errors, 3) nonrandomised concurrent cohort comparisons between contemporaneous patients eg controlled single-subject, pre-post, or matched case control series 4) nonrandomised historical cohort comparisons eg nonexperimental studies, such as comparative and correlational descriptive and case studies 5) case series without controls ie case reports. All English language publications on "growing pains" were searched and reviewed using Sackett's levels of evidence as described above.

Conclusion: Although there are more than 20 papers written about "growing pains", there is only one randomised trial (grade 2) and one nonrandomised controlled single subject design (grade 3). The remainder of the literature, with respect to management of patients, are grade 4 or 5 in Sackett's levels of evidence.
Implications for clinical practice and further research: Evaluation of the literature using Sackett's levels of evidence reveals there is currently a paucity of acceptable evidence for the management of patients with "growing pains". This poster provides a summary of the (english language) evidence available for management strategy which facilitates informed decision making by practitioners.
This review is to be repeated as stipulated by the Cochrane collaboration guidelines, such that all evidence (including non-english language) is examined and categorised by an evidence hierarchy.

* Sackett DL (1986) cited in Pratt DJ (2000). A critical review of the literature on foot orthoses. JAPMA 90(7): 339-341.Baxter MP, Dulberg C (1988). "Growing pains" in childhood - a proposal for treatment. J Ped Orthop 8(4): 402-406.Williams MT (1999). Evidence-based practice - what is evidence? Abstract - 6th National Cardiothoracic Special Group Conference, Sydney.
* Bennie PB (1894). Growing Pains. Arch Ped 11(5): 337-47.