Vol. 7, Issue 1, Part A (2025)

Nocturnal musculoskeletal pain is a common presentation in childhood and adolescence, yet it remains clinically challenging because it ranges from benign, self-limited discomfort to the first manifestation of serious disease. This systematic descriptive review synthesized contemporary evidence on epidemiology, clinical features, diagnostic approaches, and management strategies. Literature published over the past decade consistently demonstrates that most children with nocturnal limb pain are otherwise healthy, experience bilateral and intermittent lower extremity discomfort, and show normal physical examinations and laboratory findings. These cases resolve spontaneously and respond well to reassurance, stretching, massage, sleep optimization, and short-term analgesia. However, a minority of children present with features that warrant heightened concern, including persistent unilateral pain, swelling, constitutional symptoms, neurological abnormalities, or progressive functional decline. In such situations, targeted diagnostic investigations, including radiography followed by magnetic resonance imaging when appropriate, improve diagnostic accuracy while reducing unnecessary testing. Across studies, sleep disturbance, psychological stress, mechanical load, nutritional status, and family environment were identified as important modulators of pain experience, supporting a multifactorial biopsychosocial framework. Children with physical disabilities, chronic illness, or central sensitization syndromes may exhibit more complex pain trajectories requiring interdisciplinary care. Importantly, night pain alone is not a reliable predictor of infection, malignancy, or structural abnormality, underscoring the need for careful clinical reasoning rather than reflexive imaging. Overall, current evidence supports a selective, criterion-based diagnostic strategy that privileges history-taking, physical examination, and family counselling, while reserving advanced testing for atypical presentations. Early recognition of psychosocial contributors, sleep dysregulation, and functional impairment may prevent pain chronicity and improve quality of life. This review highlights the importance of balanced vigilance, avoiding both over-medicalization of benign symptoms and delayed detection of serious causes. Further prospective research is needed to refine risk stratification tools and evaluate targeted interventions.