When Bone Pain Is Not Just Growing Pains: A Comprehensive Review of Growing Pains and Pathological Bone Pain in Children

Bone pain is a frequent yet challenging complaint encountered in paediatric practice. While most cases are benign and attributable to growing pains, a significant minority may represent serious underlying conditions such as infection, inflammatory disease, metabolic disorders, or malignancy. Growing pains remain a diagnosis of exclusion, and inappropriate reassurance without adequate clinical assessment may lead to delayed diagnosis of life-threatening disorders. Conversely, indiscriminate investigations contribute to parental anxiety and unnecessary healthcare expenditure. This review provides a comprehensive and evidence-based overview of growing pains and bone pain in children, emphasizing epidemiology, pathophysiology, clinical features, red-flag signs, differential diagnoses, rational investigative strategies, and management principles. The aim is to guide paediatricians toward a structured, safe, and cost-effective approach while ensuring early recognition of pathological causes.