RLS and Growing Pains: Are They the Same Thing?

Some kids will do anything to avoid going to bed. They need a drink of water, another story, comfort and courage against the closet monster. Less obvious as a delay tactic is the one in which the child complains about the way their legs feel at bedtime.

Or, maybe, they feel compelled to move about, their legs twitchy. Some parents, who mention this to the pediatrician, may be told it’s just a case of growing pains.

But what about restless legs syndrome (RLS)?

RLS as growing pains in disguise

Yes, children do experience RLS.

This movement disorder of sleep is also a daytime phenomenon. The legs develop uncomfortable sensations at any time of day or night, usually following a period of inactivity. The legs twitch, develop “creepy crawlies,” itch, burn, or throb.

A restless child during the day may complain about this discomfort. Then, we might just encourage them to stretch, or they might race out the classroom door at the next recess period. However, at night, the challenges worsen.

Right before bed, the rituals we teach our children are part of a bigger effort to relax them. Brushing teeth, reading a book, having a glass of warm milk, or listening to music are all part of a pattern of good sleep hygiene introduced in childhood which, with any luck, they’ll carry into adulthood.

But some children will still seem antsy at bedtime. We may think they’re seeking attention or that this is the behavior of a highly active child.

RLS is easy to overlook

It’s easy to overlook RLS as the culprit. But RLS, by its very nature, qualifies as a sleep disorder because this discomfort is so hard to endure. It can delay good sleep for up to a couple of hours. Later, it may return during wakeful periods throughout the night.

Poor sleep caused by RLS can lead to chronic health and behavior problems for children, as well as persistent excessive sleepiness during the day.

The challenge for parents? Knowing when to discern between the discomfort of restless legs in their children and bedtime avoidance behavior.

About RLS in children

The Restless Legs Syndrome Foundation (RLSF) describes RLS as “a neurological condition with a genetic component, and oftentimes runs in families.”

They estimate that as many as 1.5 million children may experience RLS. Symptoms can begin when kids are young, continuing through adolescence into adulthood. The RLSF also reports that more than a third of adults with RLS began having symptoms prior to the age of 20. What’s more, 10 percent encountered RLS within the first ten years of their lives.¹

Hints that your child may have RLS

If your child has low iron levels, or if they have diabetes, kidney disease, or another neurological disorder, this should be taken into consideration. RLS can be linked to other conditions. RLS also tends to run in families.²

The following markers match the symptoms necessary for an adult to receive an RLS diagnosis. They can also mark RLS in your child:³

• An urgent need to move the legs, blaming it on vague or indescribable discomfort
• The impulse to move their legs during periods of lying or sitting
• Though these sensations occur during the day, they worsen at bedtime
• Movement seems to bring relief*

In addition to these, however, children must also be able to describe these sensations in their own words to confirm RLS. However, younger children may struggle to do this. In this case, parents should consider:³

• The severity of ongoing sleep problems the child might also have, which aren’t otherwise explained (such as due to nightmares, caffeine consumption, or diagnosed mental health disorders)
• The presence of confirmed RLS in parents and siblings
• The need for an overnight sleep study to document leg movements during sleep, which can reveal a related condition, periodic leg movement disorder (PLMD)

RLS treatments for children

Most medications used to treat adult RLS aren’t FDA approved for children, so your pediatrician may ask you to first consider nondrug treatments first. These can include caffeine avoidance, the use of heating pads or massage, management of low blood iron, and changes in other medications that might worsen RLS, such as antihistamines.

Could it still be growing pains?

Yes. Researchers define growing pains as “ill-defined limb discomforts in children that do not meet criteria for other diagnoses, such as arthritis, other bone and joint pathology, peripheral neuropathy, and radiculopathy.”⁴

Ruling out other, more serious, conditions is a likely path parents will take with a pediatrician to determine if their youngster has RLS or is simply growing like a weed and feeling it in their legs.

*In the case of growing pains, movement doesn’t adequately relieve their discomfort.