Growing Pains in Kids


“Growing pains are real because many children experience musculoskeletal pain,” says Dr. Andrew Shulman, a CHOC Pediatric Rheumatologist (Arthritis Specialist). “It’s a very common symptom but not a good name because we don’t think it’s related to growth. Typically, you will have a toddler or school-age child who in the evening after an active day or prolonged walking will complain of pain often in the ankles or legs. It can be in the calves, thighs or behind the knees. Sometimes the child will wake up in the middle of the night in pain, sometimes in tears. Usually the pain responds to massage, which the child finds soothing.”


“We think the most common cause for this type of musculoskeletal pain is flexible joints. This means the ligaments that hold the bones together at the joint are a little bit loose. They can flex and extend through a longer range of motion. Repetitive movement at the extremes of range of motion appears to cause strain and discomfort,” says Dr. Shulman, adding that the pain can also have orthopedic causes for which a child can be evaluated. “It helps if these kids stay active so they can get stronger. Strengthening the muscles that support the joints provides protection for the joints.”


“Kids do get arthritis. It’s not a common condition but it is certainly not rare,” says Dr. Shulman. According to the Arthritis Foundation:

  • Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different conditions that affect joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement.
  • Juvenile arthritis is an umbrella term used to describe the many autoimmune and inflammatory conditions that can develop in children ages 16 and younger.
  • The cause for most forms of juvenile arthritis remains unknown.

Fast Facts:

  • Number of children underage 18 affected by pediatric arthritis and rheumatologic conditions in the U.S.: 294,000
  • Number of children worldwide with juvenile arthritis; most are probably undiagnosed: 1.7-8.4 million
  • Annual cost to the U.S. economy for arthritis and related conditions, including juvenile arthritis: Almost $128 billion

Meet Dr. Shulman - CHOC Rheumatologist

Dr. Andrew Shulman specializes in the diagnosis and management of pediatric autoimmune and inflammatory conditions. As a pediatric rheumatologist, Dr. Shulman cares for patients with juvenile arthritis, lupus and other autoinflammatory diseases. He also has expertise in treating patients with Pain Amplification Syndrome, a condition where a patient has abnormal pain sensitivity. Dr. Shulman completed his residency in Pediatrics and fellowship in Pediatric Rheumatology at Boston Children’s Hospital and the University of Texas Southwestern Medical Center in Dallas.

Dr. Shulman’s philosophy of care: “My philosophy of care is to provide a multidisciplinary patient and family centered approach in the evaluation of musculoskeletal symptoms and the treatment of autoimmune and inflammatory conditions.”

University of Texas Southwestern Medical Center, Dallas, Texas

Pediatric Rheumatology

Dr. Andrew Shulman

Causes and Treatment for Pain Amplification Syndrome

Andrew Shulman, MD, PhD, pediatric rheumatologist at CHOC, dicusses the causes and treatment for this common and complex condition.

Girl wearing hat with frown on her face

Dr. Andrew Shulman Addresses Pain Amplification Syndrome

Pain amplification syndrome is a condition where a patient’s sensitivity to pain is abnormal, Dr. Andrew Shulman, a pediatric rheumatologist at CHOC, tells “American Health Journal.” Learn more about pain amplification syndrome in “American Health Journal,” a television program that airs on PBS and other national network affiliates that reach more than 30 million households.

Five Arthritis Myths Busted

Picture a person with arthritis. Do you see someone elderly with gray hair, glasses and knitting in tow?

Think again: Arthritis is not just a grandmother’s disease. In fact, one in 10 of every 10,000 children will be diagnosed with Juvenile Idiopathic Arthritis every year in the United States, and an estimated 70,000 children have the condition nationwide.

Girls outside of school with notebooks and backpacks

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