Risk factors associated with growth pain disorder in children: a systematic review and meta-analysis

Objective To systematically evaluate the risk factors associated with growth pain disorder (GP) in children and provide an evidence-based reference for its clinical diagnosis and intervention. Methods Seven electronic databases were searched from database inception to Oct 2025 to identify clinical studies investigating risk factors for GP in children. Two researchers independently screened the literature, extracted the data, and assessed the study quality. Statistical analyses were performed using Review Manager (version 5.4), and descriptive analyses were conducted for studies that could not be statistically analyzed. Results A total of 37 studies involving 16,086 participants and reporting 17 potential risk factors were included. On the basis of the current evidence, compared with healthy children, children with GP had lower serum 25-hydroxyvitamin D (25(OH)D) concentrations (SMD = −2.75, 95% CI: −3.46 to −2.04; P < 0.05) and lower bone density ( Z value) (MD = −0.07, 95% CI: −0.12 to −0.02; P = 0.008). Hypermobility/physical activity (OR = 1.34; 95% CI: 1.14–1.58; P < 0.001) might be correlated with the occurrence of GP, and overactivity and joint hypermobility are more prevalent among children with GP. Genetic or family history and psychosocial status seem to play a role in disease onset. Compared with healthy children, children with GP appeared to have lower pain thresholds and a greater number of pain points. Evidence regarding the effects of perinatal factors, breastfeeding, and picky eating on GP remains limited, and further studies are needed to prove the correlation of these factors with GP. No evidence supporting a connection between GP and bed-sharing, vascular perfusion patterns, fatty acid status, or rapid growth has been reported. Conclusion GP in children is affected by multiple factors, and our study offers a valuable reference for clinical diagnosis and treatment. However, owing to the heterogeneity and sample size of the included studies, the results should be interpreted with caution. More high-quality prospective studies are needed to further strengthen our understanding of the factors influencing GP in children. Systematic Review Registration PROSPERO CRD420251150931.