A healthy 6-year-old girl complains of deep, bilateral leg pain in the calves and thighs that wakes her several nights each week. Pain resolves by morning, is absent on days she is active, and physical examination including gait, joints, and muscles is entirely normal. What is the most likely diagnosis?

• A Osteosarcoma
• B Juvenile idiopathic arthritis
• C Growing pains (benign nocturnal limb pains of childhood) ✓
• D Restless legs syndrome secondary to iron deficiency

Explanation

Growing pains are bilateral, nocturnal, located in the calves, thighs, or shins, never present during the day, and always accompanied by a completely normal examination; they typically resolve spontaneously by adolescence. Any daytime symptoms, limp, unilateral pain, joint swelling, or abnormal examination points away from this benign entity toward arthritis or tumor.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.