Children are unreliable narrators of their own pain

A six-year-old will describe a serious problem as “a bit sore” and a splinter as unbearable, and will report both an hour after the fact. So the useful information is rarely what they say. It is when it happens, where they point, and what they have quietly stopped doing. Six questions to organize that before you ring anyone.

Written by Heath, who has lived it: casts from birth, a fusion at sixteen, the US Army, and distance running.

What is the pattern?

Six questions about the shape of the pain and not its severity. The panel builds the summary a clinician would want to hear.

When does it happen?

Where do they point?

Has anything changed in what they do?

How long has this been going on?

Has the foot’s shape changed?

Does rest help?

Why night pain is weighted so heavily

Pain from ordinary overuse quietens when the load stops. A child who has run about all day aches in the evening, sleeps, and wakes fine. That pattern is mechanical, and mechanical pain follows activity.

Pain that wakes a child from sleep is not following activity, which means something else is generating it. Most of the time that turns out to be benign. But the short list of things that do cause night pain in children includes conditions where early diagnosis matters a great deal, and no clinician will regard you as overanxious for raising it. Say the words “it wakes him at night” on the phone; it changes the urgency of the appointment you are offered.

Ordinary aches follow the day. Pain that ignores the day is asking a different question.

What “growing pains” is and is not

Growing pains is a real recognized pattern. Typically aching in both legs, in the evening or at night, in children between roughly three and twelve, with a completely normal examination and no limp or limitation the next day. Children with clubfoot (talipes equinovarus outside the United States) get them at the same rate as everyone else.

What the phrase should never be is an explanation applied to a treated foot without anybody looking at it. It is a diagnosis reached after examination finds nothing else, not a reason to skip the examination. When pain is one-sided, points to one place, or comes with any change in how a child moves, it needs a different label. And in a foot that has had surgery, the possibilities are wider than in a foot that has not.

Whether the shape is actually changing → Relapse signs by age → Whether it comes back → Socks for the boots and bar →

What to take to the appointment

A two-week diary beats any description given from memory in a waiting room. Note the date, roughly when the pain happened, what your child had been doing beforehand, where they pointed, how long it lasted, and what helped. Add photographs of both heels from behind if the shape is part of your worry.

That amount of preparation genuinely changes an appointment. It moves the conversation from “he says his foot hurts sometimes” to a pattern a clinician can work with, and it is the difference between being reassured and being understood.

The full appointment checklist →

Pain during growth

Can clubfoot cause pain during growth spurts?

It can, usually because tight or scarred tissue is under more tension as bones lengthen. Children with clubfoot also get ordinary childhood aches at the same rate as anyone else, so the pattern matters more than the presence of pain.

Is night pain in a child serious?

It is the feature clinicians weigh most heavily, because pain that wakes a child is not following activity the way mechanical pain does. It is usually benign, and the short list of causes that are not includes conditions where early diagnosis matters.

What are growing pains exactly?

A recognized pattern of aching in both legs, in the evening or at night, in children roughly three to twelve, with a normal examination and no limp the next day. It is a conclusion reached after examination, not a reason to skip one.

My child says it hurts but keeps playing. Is that reassuring?

Generally yes. Children vote with their behavior more reliably than with their words, so continuing to do everything they used to is meaningful evidence, and quietly dropping an activity is significant even when they never complain.

Should I give painkillers?

For occasional evening aches, over-the-counter children’s pain relief used as directed is reasonable. Needing it regularly is itself the signal. It means the pain is a pattern, not an incident, and the pattern is what needs assessing.

What should I bring to the appointment?

A two-week diary of when pain occurred, what preceded it, where they pointed, how long it lasted and what helped, plus dated photographs of both heels from behind. It turns a vague account into a pattern a clinician can act on.

Sources

Where this comes from

1 Clubfoot overview and treatmentAAOS OrthoInfo 2 Bracing tipsPonseti Institute, Iowa 3 Relapse of Clubfoot After Treatment With the Ponseti MethodPubMed Central 4 Classification of Relapse Pattern in Clubfoot Treated With Ponseti TechniquePubMed Central 5 Bracing in Clubfoot: Do We Know Enough?PubMed Central

Keep going

Is it getting worse? →Whether the shape itself is changing. Appointment checklist →What to prepare before you go. Sport →What activity is reasonable to encourage.