Hypermobility in Children: Growing Pains, the Beighton Score, and What Actually Helps

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Adam Foster is the founder of The Fibro Guy and one of the leading voices in hypermobility, EDS, and chronic pain rehabilitation. A former Reconnaissance Soldier, he developed chronic pain after an IED blast in Afghanistan and built his approach from the ground up when the medical system had no answers. Since 2009 he has worked with thousands of people across eight countries, drawing on pain neuroscience, motor learning, and sensorimotor rehabilitation. He co-authored "No Pain, No Pain" with trauma psychologist Dr Mairi Harper, directed the documentary "Invisible Monster," and has been featured in Forbes, BBC Radio 4, ITV News, LiveScience, and The Telegraph.

Most Bendy Children Are Just Bendy

Joint hypermobility means joints that move further than the typical range. That’s all it means. Children are more flexible than adults to begin with, and they get less flexible as they grow.

The usual way of measuring it is the Beighton score, a nine point scale. A point each side for the little finger bending back past ninety degrees, the thumb touching the forearm, the elbow hyperextending, the knee hyperextending, and one final point for putting your palms flat on the floor with straight legs.

Here’s the bit that causes most of the confusion. In children, the threshold for generalised hypermobility is a score of 6 or more^[1], and a large meta analysis looking specifically at where the line should sit landed in the same place, adding that 7 or more may be more appropriate for girls^[2]. But a lot of children still get scored against the adult cut off of 4 or 5, which flags a very large number of children whose joints are doing nothing unusual for their age^[1].

At the proper paediatric threshold, you’re looking at somewhere around 6 percent of boys and 13 percent of girls^[2]. That’s a long way from the “up to half of all children are hypermobile” figures that circulate online, and the gap between those two claims is almost entirely a scoring decision.

So if a Beighton score comes up, the useful question is which threshold it was judged against. And a score has a shelf life. Flexibility falls across childhood, and it probably persists later in adolescent girls than in boys, with the two diverging from around age 14^[1]. The same child scored at 8 and again at 15 can land in genuinely different places without anything having gone wrong. We’ve written more on why the Beighton score carries more weight than it deserves, and on being hypermobile without feeling flexible.

Is It Actually Growing Pains?

You’ll find plenty of pages, some written by clinicians, stating that growing pains are really hypermobility in disguise. It’s an appealing claim and it isn’t established. Children with growing pains do appear to be hypermobile more often than children without, but that comes from snapshot comparisons that can’t show one thing is causing the other^[3][4]. “More common in” is not “caused by”.

Here’s the far more useful thing, and almost nobody passes it on to parents. Growing pains has actual criteria, and they’re specific enough to use at the kitchen table.

The pattern that fits growing pains is intermittent pain with some pain free days and nights, felt on both sides, sitting in the muscles of the front of the thigh, the calf or behind the knee, coming on in the late afternoon or evening, with a normal examination and no limit on activity^[3].

The exclusions are where it earns its keep. It doesn’t fit growing pains if^[3]:

The pain is in the joints rather than the muscles
It’s on one side only
It’s persistent, or getting worse
It’s still there the next morning
The child is limping
There’s swelling, redness or tenderness, or a joint’s range of movement is reduced

So if your child’s pain is in the joints, or one sided, or still there at breakfast, then whatever it is, it doesn’t meet the definition of growing pains. That’s not us being clever, it’s the published criteria, and it’s a reasonable thing to say out loud in an appointment. Treat it as a prompt for a proper conversation rather than a verdict, because the criteria themselves are old and still being argued over.

One more thing, since flat feet get blamed constantly. Comparative work has found no clinically significant difference in foot posture between children with and without growing pains^[3]. That doesn’t mean feet never matter, and we’ve covered hypermobile flat feet separately, but pointing at a child’s arches and declaring the mystery solved is jumping several steps.

Bendy Does Not Mean Clumsy

This is the finding that changed how we think about it, and almost nobody writing for parents seems to have read it.

In ordinary schoolchildren, how bendy a child is tells you essentially nothing about how well they move. No meaningful relationship at all. But in children already referred for coordination difficulties, the two did relate, with more range going alongside poorer movement scores^[5]. The researchers’ own framing is the part worth keeping: coping with larger degrees of freedom may be a disadvantage when motor coordination is already struggling^[5].

Degrees of freedom is the phrase to hold onto. The more independent ways a joint can move, the more possibilities the nervous system has to manage, and the bigger the problem it has to solve. Extra range isn’t free. It’s more for the system to control. We’ve gone through that properly in our piece on motor learning for hypermobility.

That’s why two children with identical scores can look completely different, one of them scrambling up a climbing frame without a thought and the other tripping over flat ground. Chasing the score misses the point. What you want to know is whether the child can control the range they’ve got, and control is the part that responds to practice.

What Else To Watch For

Among children who end up in a hypermobility clinic, pain in more than one joint is the commonest complaint, and it’s rarely the only thing going on^[1].

Fatigue matters more than most people expect. Worse fatigue tracked with more functional impairment three years later^[1]. Not pain, fatigue. It’s the symptom parents mention last and clinicians skip first, and it’s the one that predicts how much of life a child can actually take part in.

Mood is part of it too. A child who’s been sore and tired and quietly worried about their body for a couple of years is carrying something beyond joints, which is why we’ve written separately about hypermobility and anxiety, fear of movement and sleep.

Then there’s ADHD and autism, which parents ask about constantly. In clinic samples of children already diagnosed with a hypermobility condition, ADHD turns up more often than you’d expect from the general population^[6]. But a school based study that scored ordinary eleven year olds found no link between hypermobility and neurodevelopmental problems at any level, measured not as tick box diagnoses but as a graded severity rating agreed jointly by a psychiatrist, a psychologist and a paediatric neurologist, plus parent and teacher questionnaires^[7].

Those two aren’t really in conflict. One counted children already diagnosed and attending a clinic. The other counted ordinary schoolchildren who happened to score high on a flexibility test. Something that travels with a clinic diagnosis needn’t travel with the trait on its own. The school study was also small enough that it could only have picked up a large difference, so it doesn’t close the question^[7]. Our post on whether hypermobility is linked to autism goes deeper.

One figure from that same school cohort is worth carrying away regardless. Around 42 percent of the eleven year olds reported weekly musculoskeletal pain, and being hypermobile made no meaningful difference to it^[7]. A lot of children ache. Flexibility isn’t what separates them, which is worth remembering before you pin every complaint on your child’s joints.

Why Nobody Will Diagnose Your Child With hEDS Yet

This catches families out badly, usually after a long wait and a lot of hope pinned on one appointment.

The 2017 criteria for hypermobile Ehlers Danlos syndrome were built on adult evidence and expert consensus, and the paediatric guidance is direct: children shouldn’t be assessed with them or diagnosed with hEDS until they’ve reached biological maturity^[1]. The reason runs through this whole article. Children are hypermobile as a normal feature of being children, which makes separating an ordinary trait from an underlying disorder genuinely difficult^[1].

That’s frustrating if you’ve spent two years fighting to be taken seriously. But separate two things. “We’re not applying an adult label to a growing child yet” is defensible caution. “There’s nothing wrong, go away” is a brush off. Plenty of families get the second dressed up as the first.

A child can have symptomatic hypermobility that deserves proper management without carrying a syndrome label. Pain, fatigue, poor coordination and a struggle with PE are all treatable in their own right, and none of them need a diagnosis first. Our pieces on how hypermobility and EDS are diagnosed, the road to the new EDS classification and what gets mistaken for hypermobility cover the rest.

What Actually Helps

Two trials are worth knowing about, and between them they answer two questions parents actually ask.

Is it dangerous to let a hypermobile knee go past straight? A trial split children with hypermobility and knee pain into two groups. One exercised into their full hyperextension range, the other was kept strictly at neutral. Pain improved, and it improved about the same either way^[8]. So if you’ve been told your child must never let a knee straighten past neutral, that fear isn’t well supported. It fits what we argue about range and stretching generally.

Do you need a full multidisciplinary team? A larger trial compared an eight week programme of physiotherapy, occupational therapy, gait analysis and a school visit against a single rheumatology appointment with good education and advice. The intensive version produced no additional benefit. Both groups improved on pain, coordination and grip strength^[9]. That’s genuinely useful for families who can’t access a specialist team, though a good chunk of the standard care group went and arranged extra therapy privately, which muddies it^[9].

Broader reviews point the same way, with evidence that improving general physical fitness helps hypermobile children, though it rests on very little^[10]. And one honest caveat across all of it: neither trial had a group left alone as a comparison, so “children got better” isn’t quite the same as “the treatment worked”. The direction of travel is consistent even if the certainty isn’t.

How We’d Actually Train A Hypermobile Child

This part is how we work, which is a different claim to the evidence above and should be read as one. It’s built on the motor learning literature and on what happens in our studios.

The starting principle is signal before load. If the difficulty is managing the range rather than the range itself, then control is a learning problem before it’s a strength problem. Give the nervous system clearer information about where a joint actually is, and only then ask it to do something demanding there. We’ve laid the model out in our pieces on proprioception and body maps and on why hypermobile muscles feel tight and weak at once.

Make it a game, not a programme. A seven year old will not do three sets of anything for six weeks, and treating that as non compliance is a category error. Balance challenges, animal walks, obstacle courses, hopping games. The motor learning happens either way, and the child doesn’t experience themselves as a patient doing rehab. That last part matters more than the exercise selection.

Vary the conditions, not the activity. Same handful of movements, different speeds, different surfaces, standing and sitting versions. Variety inside a familiar task transfers to a playground. Endless novelty just means nothing gets learned properly.

Short and often beats long and occasional. Ten focused minutes several times a week does more than an hour at the weekend, and it survives contact with a real family’s schedule.

Don’t build a fear of movement while trying to prevent injury. This is the one we’d most want parents to hear. A child repeatedly told their joints are fragile, pulled out of PE, warned off trampolines and climbing frames, learns that their body is dangerous. That lesson lasts far longer than a sprain does, and we spend a great deal of time undoing it in adults who learned it at nine. Sensible modification is fine. A running commentary about fragility is not.

Watch the fatigue, not just the pain. Treat tiredness as information rather than as a child being difficult^[1]. Our guide to pacing is written for adults but the principles scale down.

Keep the horizon long. A child’s joints will change through puberty whatever you do^[1]. The aim isn’t to fix a score, it’s to hand a teenager a body they trust and some idea of how to look after it.

Before Your Next Appointment

Write the pattern down. Where the pain is, muscles or joints, one side or both, what time of day, whether it’s gone by morning, what makes it worse. Ten minutes goes fast, and a parent who arrives with a pattern gets taken more seriously than one describing a general worry. That list also maps straight onto the growing pains criteria above^[3].

Ask which threshold a Beighton score was judged against. A child scoring 5 against a paediatric threshold of 6 is a completely different conversation from a child scoring 5 against an adult one^[1][2].

Mention the fatigue, the mood and the coordination. Not just the joints. Coordination in particular is the bit most likely to be dismissed as clumsiness and most likely to respond to training.

Get them moving in whatever way they’ll actually keep doing. Swimming, climbing, dance, martial arts, whatever they’ll turn up to. The specific protocol matters less than something happening^[8][9].

Push back gently on a label that doesn’t fit. Not aggressively, and not with a printout of this article. “It’s in her knees and it’s still there in the morning, does that still fit growing pains?” is specific, reasonable and hard to wave away.

If you want the structured version of how we work with this, the Hypermobility Live Workshop breaks down the frameworks we use in the studios, with live sessions where you can ask about your own situation.

Frequently Asked Questions

Will my child grow out of being hypermobile?

Flexibility does reduce across childhood, and it probably persists later in girls than boys, with the two diverging from around 14^[1]. So the score often falls. Whether the symptoms follow it down is a separate question, and planning on the assumption that it all resolves by itself is optimistic. Our post on whether EDS gets worse with age covers the adult end.

Should my hypermobile child avoid stretching?

We wouldn’t build a programme around end range stretching for a child who already has more range than they can control, because the problem is rarely a shortage of movement. That’s different from a warm up, and the knee trial is a useful check on the fear: children exercising into full hyperextension did no worse on pain than children kept strictly at neutral^[8]. Our stretching guide works through the reasoning.

Are growing pains really just hypermobility?

Not established, no. Children with growing pains do seem to be hypermobile more often than children without, but that’s a snapshot comparison and it can’t show the bendiness is causing the pain^[3][4]. The more useful move is to check whether the pain meets the growing pains criteria at all, since joint pain, one sided pain, limping and pain still present the next morning are all exclusions^[3].

My hypermobile child is clumsy. Are the two connected?

In ordinary schoolchildren, how bendy a child is tells you essentially nothing about their movement skill. In children already referred for coordination difficulties, the two did relate^[5]. So flexibility alone doesn’t predict clumsiness. If both are present, that’s worth acting on, and coordination is trainable.

The Honest Summary

Most bendy children are just bendy, and the alarming numbers usually come from scoring a child against an adult threshold. Growing pains is a real pattern with real criteria, and checking your child’s pain against them is more useful than arguing about whether hypermobility caused it. Flexibility on its own doesn’t make a child clumsy or sore. Flexibility the nervous system hasn’t learned to manage is a different matter, and that’s the part that shifts with practice.

For the children who are genuinely struggling, watch the fatigue as closely as the pain, keep them moving in whatever way they’ll stick with, build control rather than chasing a score, and be very careful not to teach a child that their body is a liability. Most of what we undo in adults was learned in childhood, and that last part is the bit you actually have some say over.

Next read: exercises for hypermobile children, our wider exercise and rehabilitation guide and the hypermobility and EDS guide. If your child’s trouble sits somewhere specific, we’ve also got knees, core, jaw pain, rib subluxation, running, the symptom picture and flare ups.

– Adam –

References

[1] Tofts LJ, Simmonds J, Schwartz SB, et al. Pediatric joint hypermobility: a diagnostic framework and narrative review. Orphanet Journal of Rare Diseases 2023;18:104. doi: 10.1186/s13023-023-02717-2

[2] Williams CM, Welch JJ, Scheper M, et al. Variability of joint hypermobility in children: a meta-analytic approach to set cut-off scores. European Journal of Pediatrics 2024;183(8):3517-3529. doi: 10.1007/s00431-024-05621-4

[3] Evans AM. Growing pains: contemporary knowledge and recommended practice. Journal of Foot and Ankle Research 2008;1:4. doi: 10.1186/1757-1146-1-4

[4] Luo T, Huang Y, Guo Y, Lian X. Risk factors associated with growth pain disorder in children: a systematic review and meta-analysis. Frontiers in Pediatrics 2026;14:1806380. doi: 10.3389/fped.2026.1806380

[5] Jelsma LD, Geuze RH, Klerks MH, et al. The relationship between joint mobility and motor performance in children with and without the diagnosis of developmental coordination disorder. BMC Pediatrics 2013;13:35. doi: 10.1186/1471-2431-13-35

[6] Kindgren E, Quiñones Perez A, Knez R. Prevalence of ADHD and Autism Spectrum Disorder in Children with Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome: A Retrospective Study. Neuropsychiatric Disease and Treatment 2021;17:379-388. doi: 10.2147/NDT.S290494

[7] Glans MR, Aziz A, Kindgren E, et al. No association between joint hypermobility, musculoskeletal pain and neurodevelopmental problems in a school-based sample of 11-year-old children. BJPsych Open 2025;11(6):e262. doi: 10.1192/bjo.2025.10881

[8] Pacey V, Tofts L, Adams RD, et al. Exercise in children with joint hypermobility syndrome and knee pain: a randomised controlled trial comparing exercise into hypermobile versus neutral knee extension. Pediatric Rheumatology 2013;11:30. doi: 10.1186/1546-0096-11-30

[9] Bale P, Easton V, Bacon H, et al. The effectiveness of a multidisciplinary intervention strategy for the treatment of symptomatic joint hypermobility in childhood: a randomised, single Centre parallel group trial (The Bendy Study). Pediatric Rheumatology 2019;17:2. doi: 10.1186/s12969-018-0298-x

[10] Scheper MC, Engelbert RHH, Rameckers EAA, et al. Children with Generalised Joint Hypermobility and Musculoskeletal Complaints: State of the Art on Diagnostics, Clinical Characteristics, and Treatment. BioMed Research International 2013;2013:121054. doi: 10.1155/2013/121054