Development of Conceptual and Process Models of Growing Pains: A Mixed-Method Research Design

Abstract

Despite being a common childhood complaint there is little research on growing pains. Existing research is inconsistent with regard to sample selection and prevalence rates. There are only two English language intervention studies, and with the exception of associations noted in prevalence research, there has been no systematic research on the potential impact of growing pains on daily activities. Lack of a universal definition of growing pains poses difficulty for both diagnosis and research. The purposes of the current investigation were to propose a definition of growing pains grounded in literature and clinical practice, to develop a conceptual model of growing pains, and to understand children’s experiences with growing pains. A mixed-method research program involved four phases. In phase I, a survey of physicians indicated the following definition of growing pains: Intermittent pain of unknown etiology, occurring nocturnally in the lower limbs. Features that may occur in some cases, but not part of the definition, include arm pain and daytime pain. In phase II, non-parametric statistical analyses of child, familial, and environmental variables in a rheumatology clinic database were conducted to determine potential risk factors for growing pains. Logistic regression modeling indicated an association between growing pains and maternal illness or rash during the pregnancy, maternal smoking during the pregnancy, delayed pull to standing (i.e., greater than age 10 months), and family histories of back pain and arthritis. Potential mechanisms for these empirical associations are explored. In phase III, qualitative interviews with children were conducted to develop a grounded theory of how children process their experiences. Children engaged in a process of evaluating their current and past experiences of growing pains to determine how to manage specific pain episodes. Their evaluation was influenced by how they understood their pain which in turn was influenced by their intrapersonal and interpersonal experiences. Phase IV integrated results and existing literature to develop a conceptual model of growing pains which outlines characteristic features, predisposing factors, triggers, alleviating actions, and associated psychosocial features. Implications of the process theory and the conceptual model of growing pains with regard to clinical practice and future research are discussed.