Symptom definition:

• Pains in the arms or legs.
• The pain is not due to a known injury.

Causes:

• Main causes: muscle spasms and strained muscles from overuse (e.g., excessive throwing and jumping).
• Brief pains (one to 15 minutes) are usually due to muscle spasms. Foot or calf muscles are especially prone to cramps that awaken from sleep.
• Continuous acute pains (hours to three days) are usually due to overstrenuous activities or forgotten muscle injuries during the preceding day.
• Serious causes: fractures or swollen joints (arthritis).
• See also arm or leg injury

Call your doctor now (night or day) if:

• Your child looks or acts very sick.
• Swollen joint or can't move joint fully.
• Calf pain on one side lasts more than 12 hours.
• Bright red area on skin.
• Muscle weakness or can't stand or walk.
• Tingling (pins and needles) sensation present more than one hour.
• Severe pain or cries when limb touched or moved.

Call your doctor within 24 hours if:

• You think your child needs to be seen.
• Fever is present.
• Pain makes child walk abnormally (has limp).

Call your doctor during weekday office hours if:

• You have other questions or concerns.
• Cause of limb pain is uncertain.
• Limb pain present longer than seven days.
• Limb pains are a recurrent problem.

Parent care at home if:

• Caused by muscle cramps in the calf or foot.
• Caused by strained muscles from excessive use.
• Cause is obvious and harmless (e.g., tight new shoes, a shot within last 24 hours).

Home care advice for muscle cramps or muscle strains:

1. Treatment For muscle cramps: Muscle cramps in the feet or calf muscles occur in a third of children. During attacks, stretch the painful muscle by pulling the foot and toes upward as far as they will go to break the spasm. Stretch the muscle in the direction opposite to how it is being pulled by the cramp or spasm. Massage the painful muscle with an ice pack for 20 minutes. If these are heat cramps (occurring during exercise on a hot day), give lots of water to drink in addition to stretching the muscle and an ice pack. Future attacks may be prevented by daily stretching exercises of the heel cords. Stand with the knees straight and stretch the ankles by leaning forward against a wall. Also give the feet more room to move at night by placing a pillow under the covers at the foot of the bed.

2. Treatment For strained muscles From excessive use:  Massage the sore muscles with ice for 20 minutes several times on the first two days. Give acetaminophen (e.g. Tylenol) or ibuprofen for pain relief. If stiffness persists more than 48 hours, have your child relax in a hot bath for 20 minutes twice a day, and gently exercise the involved part under water.

Expected course

• Muscle cramps usually last five to 30 minutes. Once they resolve, the muscle returns to normal quickly.
• A strained muscle hurts for two or three days. The pain often peaks on day two. 

Call your doctor if:

• Muscle cramps occur more frequently.
• Child develops a limp, a swollen joint, or a fever.
• Pain caused by work or exercise persists longer than seven days
• Pain becomes worse.
• Your child becomes worse or develops any of the "Call Your Doctor" symptoms.