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

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Adam Foster

Director at The Fibro Guy

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.

Latest posts by Adam Foster (see all)

• Teeth, Gums and Jaw Pain in hEDS, and How to Get Through a Dental Appointment - 28 September 2026
• Why ADHD and Hypermobility Keep Turning Up Together - 16 September 2026
• Hypermobility and Early Development: Milestones, Motor Delay, and Predictions - 12 September 2026

If your child bends in ways that make other parents wince, and somebody has already told you it’s growing pains and they’ll grow out of it, here’s the short version. Most hypermobile children are just hypermobile. Hypermobility isn’t a disease, it’s very common in childhood, and most of the time it isn’t the reason a child hurts. But some hypermobile children genuinely do struggle, and they get missed, because the thing that matters isn’t how far the joints move. It’s whether the child can control the range they’ve got.

This post covers what’s worth knowing, what’s worth asking at an appointment, and what actually helps. It won’t diagnose your child or hand you a programme to start tomorrow. If the practical layer is what you’re after, we’ve got a separate piece on exercises for hypermobile children.

Most Hypermobile Children Are Just Hypermobile

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, with a point each side for the little finger bending back past ninety degrees, the thumb touching the forearm, the elbow hyperextending and the knee hyperextending, plus 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 6 or more out of 9, and it sits there because that’s the far end of ordinary childhood flexibility, not because it’s a tidy number ^[1]. Pooling everything published on where the line should sit lands in the same place, and adds, on limited evidence, that 7 or more may be more appropriate in some children, girls in particular ^[2]. Score a child against the adult cut off of 4 or 5 instead and the arithmetic goes somewhere silly. In one study of schoolchildren the lower cut offs produced prevalence figures the authors themselves called implausible, while a cut off of 7 brought the general population estimate back down to around 6 percent ^[5].

At the paediatric threshold you’re looking at roughly 6 percent of boys and 13 percent of girls ^[2]. That’s a long way from the figures that get repeated online, and the gap between the two is almost entirely a scoring decision rather than anything about children. So when a Beighton score comes up, the useful question is which threshold it was judged against. A score also has a shelf life. Hypermobility decreases through the paediatric years, probably later in adolescent girls than in boys, with the two clearly parting company around the age of 14 ^[1]. The same child scored at 8 and again at 15 can land in genuinely different places without anything having gone wrong.

Is It Actually Growing Pains?

You’ll find plenty of pages, some of them 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 turn up hypermobile more often than children without, and one study inside a recent review put it at 61.4 percent against 32.8 percent ^[4]. But those are snapshot comparisons, and the authors of that review say plainly that the studies were mostly observational, the diagnostic criteria were inconsistent between them, and causality remains uncertain ^[4]. More common in is not caused by.

The far more useful thing, and the bit that rarely makes it as far as a parent, is that growing pains has published criteria, and they’re specific enough to use at the kitchen table. The pattern that fits is intermittent pain with some pain free days and nights, felt on both sides, sitting in the muscles at 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 on one side, or still there at breakfast, then whatever it is, it doesn’t meet the definition of growing pains. That isn’t us being clever, it’s the published table, 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. There’s no single diagnostic test for growing pains, which is exactly why the criteria are written as a list of what it isn’t, and why unilateral or articular pain is the bit that sends a clinician looking harder ^[3].

One more thing, since flat feet get blamed constantly. Comparative work found no clinically significant difference in foot posture between children with and without growing pains, and the review that reports it lists “growing pains is not associated with flat feet” among its conclusions ^[3]. That doesn’t mean feet never matter. It means pointing at a child’s arches and declaring the mystery solved is jumping several steps. The wider picture is messier than any single cause anyway. Pull the growing pains literature together and lower vitamin D, slightly lower bone density, family history, psychosocial factors, lower pain thresholds and how active a child is all turn up alongside it, with no way yet of telling which of them is doing anything ^[4].

Hypermobile Does Not Mean Clumsy

In ordinary schoolchildren, how hypermobile a child is tells you essentially nothing about how well they move. In children already referred for coordination difficulties, the two did relate, with more range going alongside poorer movement scores, and knee hyperextension the strongest of them ^[5]. The authors’ own conclusion is the part worth keeping: coping with hypermobility or larger degrees of freedom may be a disadvantage when motor coordination is deficient ^[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 to control, which is the argument we work through at length in motor learning for hypermobility. It’s also 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 reach a hypermobility clinic, joint pain is the commonest complaint and it’s rarely the only thing going on. In one clinical cohort of 89 children aged 6 to 16, 94 percent reported pain in more than one joint, a mean of just over six joints each, most often the knee, the foot and the ankle ^[1].

Fatigue matters more than most people expect. In that same cohort, worse fatigue tracked with more functional impairment three years later, and with worse quality of life at the start ^[1]. Not pain, fatigue. It’s the symptom that best tracks how much of life a child can take part in, and it’s usually the one mentioned last. Mood belongs in the same conversation. A child who’s been sore and tired and quietly worried about their own body for a couple of years is carrying something that isn’t in their joints, and it’s worth naming at an appointment rather than leaving it to come out sideways.

Then there’s ADHD and autism, which parents ask about constantly. In a retrospective review of 201 children already diagnosed with a hypermobility spectrum disorder or hEDS at a specialist clinic, 16 percent had a confirmed ADHD diagnosis, another 7 percent were being assessed for one, and 6 percent had an autism diagnosis, with the ADHD rates higher in hEDS than in HSD and rising steeply through adolescence ^[6]. But a school based study of ordinary eleven year olds found no association between high Beighton scores and neurodevelopmental problems, and it wasn’t measured by ticking boxes: severity was rated on a graded scale after a case conference attended by a psychiatrist, a psychologist and a paediatric neurologist, with parent and teacher rating scales feeding into it ^[7].

Those two aren’t really in conflict. One counted children already diagnosed and attending a clinic. The other counted 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 authors of the school study also point out that they had no information on puberty and that a type 2 error is possible, so no association in that sample isn’t the same as no relationship across development ^[7].

One figure from that cohort is worth carrying away regardless. 42 percent of the eleven year olds reported weekly musculoskeletal pain, and the hypermobile children were no likelier to be among them, though the hypermobile subgroup was small enough that the comparison can’t carry much weight ^[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 framework is direct about it: children shouldn’t be assessed against those criteria or diagnosed with hEDS until they’ve reached biological maturity ^[1]. The reason runs through this whole article. Children have high levels of hypermobility as an ordinary feature of being children, which makes separating a normal physical trait from an underlying disorder genuinely difficult ^[1]. That framework also treats the diagnosis as something that moves rather than something fixed, because hypermobility can resolve, symptoms can settle, or new features can appear as a child matures ^[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, and plenty of families get the second one dressed up as the first. A child can have symptomatic hypermobility that deserves proper management without carrying a syndrome label, and pain, fatigue, poor coordination and a struggle with PE are all worth treating in their own right. None of them need a diagnosis first.

Free guides

The Parents School Guide

If your child has hypermobility, EDS or chronic pain, they have legal rights at school. Most parents have never been told what those rights are, and plenty of schools do not know either. These guides set it out.

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? Children aged 7 to 16 with joint hypermobility syndrome and knee pain were split into two groups, one exercising into their full hyperextension range and the other kept strictly at neutral. Both improved, and by a similar amount. Mean knee pain fell by 36 percent, worst knee pain by 32 percent and parent reported bodily pain by 37 percent, with nothing going wrong in either group ^[8]. The two approaches only came apart on parent reported secondary measures, where psychosocial scores favoured training into the hypermobile range and physical health scores favoured neutral only ^[8]. So if you’ve been told your child must never let a knee straighten past neutral, that fear isn’t well supported.

Do you need a full multidisciplinary team? This one has been tested properly, on a decent number of children, and the answer is no. Children with symptomatic hypermobility were put on one of two paths. The first was an eight week individualised programme: three physiotherapy sessions, gait analysis with orthoses where needed, an occupational therapy assessment at the clinic and at home, and a joint school visit to brief the teachers. The second was standard care, meaning one paediatric rheumatology appointment of about half an hour with verbal advice and a leaflet ^[9]. Over twelve months both groups improved on pain, coordination and grip strength, and the intensive version added nothing on top ^[9]. That’s genuinely useful for families who can’t reach a specialist team. The caveat the authors raise themselves is that 60 percent of the standard care group ended up having at least one extra physiotherapy or occupational therapy session anyway, so standard care wasn’t quite nothing ^[9].

Pull the wider paediatric literature together and it points the same way, with evidence that improving physical fitness helps children with joint hypermobility syndrome, and an explicit warning attached that the conclusion rests on two studies in children ^[10]. And one honest caveat sits across all of it. Neither trial had a group left alone as a comparison, so “children got better” isn’t the same as “the treatment worked”. The direction of travel is consistent even where the certainty isn’t.

How We’d Actually Train A Hypermobile Child

This section is how we work, and it’s a different sort of claim to everything above it. It’s built on general motor learning research and on what happens in our studios, not on trials in hypermobile children, and the treatment literature in this group is two paediatric studies deep ^[10]. Read it as our practice rather than as a finding.

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. That ordering is our read, and if a head to head trial lands and says we had it backwards, we’ll teach the other thing.

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 it as rehab. That last part matters more than the exercise selection does.

Vary the conditions, not the activity. Same handful of movements, different speeds, different surfaces, standing and sitting versions. Variety inside a familiar task is what transfers to a playground. Keep it modest, though. More variation isn’t automatically more learning, and 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 and warned off trampolines and climbing frames learns that their body is dangerous. That lesson lasts a great deal longer than a sprain does, and we spend a lot 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, given how closely it tracked function three years on ^[1].

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 written off 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?

Hypermobility does decrease through childhood, probably later in girls than boys, with the sexes diverging 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.

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].

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 comes from snapshot comparisons that can’t show the hypermobility is causing the pain, and the review reporting it says as much ^[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 hypermobile 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 hypermobile children are just hypermobile, 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. If you want the adult picture for yourself as well, start with our hypermobility and EDS guide.

– 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