It is quite difficult to see your child wake in the middle of the night due to severe pain in the leg. Most of the time, the pain goes away in the morning but it leaves you wondering if you should do something about it or ignore it altogether. The chances are the pain your child experiences is just growing pains, but it can be something else. Knee pain in children is sometimes an early sign of arthritis or another rheumatic disease. Keep reading to find out more about the causes.

Causes and Treatment for Knee Pain in Children

Knee pain may indicate a number of issues. Here are some of the most common causes.

1. Growing Pains

What causes growing pains is not clear, and there is no evidence that child's growth is painful. Some experts believe that growing pains are linked to restless leg syndrome, but it may also happen due to overuse from activities such as climbing, running and jumping during the day.

Symptoms: The most common symptom is throbbing feeling in the legs. The pain usually occurs in the calves, in the front of the thighs or behind the knees. Some children also experience headache or abdominal pain during episodes of growing pains.

Treatment: While there is no treatment for these pains, they improve on their own within a couple of years. Even if they do not go away, they become less painful after the first year. Massaging your child's legs may help ease some discomfort.

2. Jumper's Knee

Kids that play sports with lots of jumping and squatting may overuse the patellar tendon, which results in the development of Jumper's knee. Excessive squatting puts serious pressure on the patellar tendon and causes injury to the fibers of the tendon. This leads to inflammation and pain. Abnormal alignment of the lower limbs may be a cause of Jumper's knee. It means that kids who are flat-footed or knock-kneed may develop this condition.

Symptoms: The most common symptom is tenderness and pain over the patellar tendon right below the kneecap. You may also notice swelling around the same area. Your child will feel pain when jumping, squatting, or doing anything that uses the quadriceps muscle.

Treatment: You need to ensure that your child stops sports activities for some time until they feel better and the swelling goes away completely. You cannot do much if jumper's knee has affected your child before the skeleton has stopped growing.

Doctors may also prescribe anti-inflammatory medicine to reduce knee pain in children. Your child may even have to wear knee straps and sleeves for support.

Physical therapy and using of heat, ice to control pain and inflammation prove effective too. If pain is severe, your doctor may recommend giving cortisone injections to your child. Your child needs surgery in rare cases, especially when there is an issue with the tendon, not with the growth plate.

3. Osgood-Schlatter Disease

Growth spurts may cause problems because children’s muscles, bones and tendons grow quickly and usually not at the same time. This puts more pressure on some muscle groups and even places stress on the growth plate right at the top of the shinbone. The pain can be mild to severe and may persist for weeks and even months.

Symptoms: The most common symptoms include limping after exercise, tenderness under the knee, swelling over the shinbone, and tightness of the hamstring and quadriceps muscles. The pain usually becomes manageable with rest and worsens with exercise.

Treatment: The pain goes away when children's bones stop growing.

• Rest will help reduce the pain. Limiting the activities often helps, but kids can continue with certain activities as long as it only causes a mild pain.
• Wearing shock-absorbent insoles really helps, so does the use of moist heat for 15 minutes before activity.
• Basketball kneepads and wrestling gel pads really help protect your child's tender shin from bruises.
• The doctor may recommend OTC pain relievers, such as ibuprofen.
• Physical therapy is essential for restoring the range of motion and strengthening the muscles if your child is returning to normal activities after a short break. HERE are 12 best  exercises for Osgood Schlatter.

4. Juvenile Rheumatoid Arthritis (JRA)

The cause of juvenile rheumatoid arthritis is not clear, but as it is an autoimmune disease, it has something to do with white cells that fail to differentiate between germs and the body's healthy cells. This triggers an immune response that releases chemicals that damage healthy tissues, causing pain and inflammation.

Symptoms: Knee pain in children is the most common sign of this autoimmune disorder. It usually affects kids between 6 months to 16 years of age. You may also notice warm and reddened joints with swelling around the affected joint. Symptoms may vary a bit depending on different types of Juvenile rheumatoid arthritis. The most common types are systemic JIA, oligoarthritis, Polyarticular arthritis (rheumatoid factor negative), psoriatic arthritis, polyarticular arthritis (rheumatoid factor positive), enthesitis-related arthritis and undifferentiated arthritis. Different joints become affected in different types of juvenile rheumatoid arthritis, but the pain, swelling, warmth and tenderness are some of the most common symptoms in all cases.

Treatment: The use of a combination of physical therapy, medication and exercise helps relieve symptoms. Corticosteroid injections may also help reduce swelling and pain. You will have to work with your child's primary care physician, physical therapist and rheumatologist together to determine the best treatment option.

Exercise to Ease the Pain

Knee pain in children may respond well to certain exercises. Doing stretching and strengthening exercises will help make them feel better.

Stretching Exercise

It is important to stretch muscles before and after sports activities to reduce chances of injury.

• Hamstring stretch: It involves stretching with one leg hanging by the side of a bench and the other kept straight. Slowly move forward while bringing your chest close to the knee. Make sure to keep your back straight.
• Quadriceps stretch: Stand on one foot and place your hand on a wall for support. Pull your other leg up and behind to touch your buttocks lightly. Make sure to keep your knees close and back straight.

Strengthening Exercise

• Straight less raise strengthening: Lie down on the floor with your face towards the roof. While keeping your big toe up, turn your foot out slightly and tighten your quadriceps muscles. Make sure the foot is elevated 6-12 inches of the ground.
• Wall squat strengthening with pillow: Stand against a wall with your back straight and feet shoulder-width apart. Place a pillow between your knees and join your knees together. Lower your body very slowly while keeping your back against the wall. Keep lowering until your knees are at 60 degrees flexion. Hold this position for a few seconds and return to the starting position.