Back pain in kids has become a common complaint. A study in 2019 noted that out of the 1,236 pediatric participants, 34% reported back pain, while 9% reported severe back pain (1). Most cases of back pain in children may usually resolve with the help of physical therapy. However, it is safe to consult a pediatrician, especially if the child is younger than five years.
Keep reading to know more about the causes, symptoms, diagnosis, treatment, and prevention of back pain among children.
Is It Normal For Children To Have Back Pain?
Back pain was considered uncommon in children; however, recent studies suggest that by 15 years of age, 20–70% of children will complain about back pain at some point (2).
That said, short-term back pain might not indicate any underlying issue (2). Nevertheless, if children complain of persistent pain in a particular area or if their pain is accompanied by fever and weight loss, it needs to be addressed at the earliest (3).
Causes And Risk Factors For Back Pain In Children
Back pain among children is not always problematic.
Most cases of back pain occur due to muscular strain, commonly in the lower back. Wrong exercise techniques and injuries could also contribute to the pain (2).
- Poor posture
- Gender—back pain is more common in girls than boys
- Age—children aged 12 years and above are more prone to back pain than younger children
- Weak and stiff back muscles
- Weak core muscles
- Sedentary lifestyle
- Improperly packed heavy backpacks
- Sports that require rigorous practice, such as gymnastics, football, horse riding, and rowing
1. Spinal stress fracture (spondylolysis): This condition mostly affects the lower back and generally occurs in growing children who are active in sports such as gymnastics and diving. It could also be a result of growth spurts.
2. Slipped vertebrae (spondylolisthesis): This condition is often a complication of spondylolysis and is caused when a vertebra, mostly in the lower part of the spine, moves over the vertebra below it. In severe cases, the bone presses on the nerves.
3. Rounded back (Scheuermann’s kyphosis): This skeletal deformity gives a hump-like curvature to the spine. This condition is caused by a growth disorder of the vertebrae.
4. Infection: Often, back pain occurs due to infection in the disk space (e.g. Pott’s Disease). This condition is more common in younger children and is characterized by lower back pain, stiffness of the spine, or difficulty bending.
5. Spinal cord tumor: Spinal cord tumors in children are rare, but when they occur, they can cause severe back pain. The pain aggravates with time and does not diminish with rest. Tumors mostly appear in the middle and lower back and require immediate medical attention.
Symptoms Of Back Pain In Children
The symptoms of back pain may vary among children depending on the underlying cause. However, some of the common symptoms include (6)
- Pain with movement
- Pain after prolonged sitting
- Muscle spasms
- Stiff back muscles
- Painful muscles around the spine
When Should You Worry About Your Child’s Back Pain?
- Chronic pain that lasts longer than four weeks
- Pain extending to the legs and causing weakness or numbness
- Night pains that hamper sleep
- Chronic pain that disrupts normal activities
- Back pain accompanied by fever or night sweats
- Weight loss
- Pain accompanied by changes in bowel or bladder habits
- Chronic pain that does not reduce with rest
Diagnosis Of Back Pain In Children
Although most cases of back pain improve with conservative treatment options, such as physical therapy, it is recommended to consult a pediatric spine specialist to avoid serious complications.
Specialists examine children by doing physical checks and studying their general health. Hence, preparing the answers to the following questions would help the pediatric spine specialist accurately determine the nature of the back pain (7).
- How old is the child?
- Is the constant pain inhibiting the child from participating in normal activities?
- Can the child walk properly and bend with ease?
- Where is the pain located, and how long or intense are the episodes?
- Is the pain accompanied by fever or chills?
- Has the child lost weight?
- How is the appearance of the child’s back (check the curvature or if there are any unusual features)?
- Is the pain causing numbness or tingling in any part of the body?
- Is the pain alleviated with non-steroidal anti-inflammatory drugs, such as ibuprofen?
1. Radiograph: Radiographic findings are useful for identifying non-muscular back pains, such as those caused by vertebral fractures.
2. Magnetic resonance imaging (MRI): An MRI is suggested for patients who have experienced back pain for more than six weeks. Such pain is likely to be related to an infection or other serious conditions.
3. Computerized tomography (CT) scan: A CT scan enables doctors to understand the bone structure after a fracture, infection, or spinal tumor.
4. Bone scan: A bone scan creates images of the bones and helps diagnose different bone diseases.
5. Laboratory tests: Laboratory tests are mostly recommended when the back pain is related to an infection or inflammation. The recommended blood tests are complete blood count, erythrocyte sedimentation rate, and C-reactive protein measurement. In the case of suspected tuberculosis, a tuberculin skin test (TST) or purified protein derivative (PPD) test can be requested.
Treatments For Back Pain In Children
Typically, children do not require complicated treatments or surgery for back pain and can instead opt for the following treatment options (6).
- Following a consistent exercise program for around six to eight weeks
- Doing activities such as yoga, cycling, swimming, or Pilates to strengthen the back and abdominal muscles
- Alternative treatments like acupuncture, massage, and chiropractic care
The following table illustrates the causes and necessary treatment options for several back-related concerns in children (9).
|Concern||Possible cause||Action to take|
|Your child fell or experienced a minor injury while playing.|
|Your child fell from a great height.|
|After an injury, your child is experiencing numbness or tingling in the limbs or has lost bladder and bowel control.|
|The child has sharp one-sided pain in the middle of the back. The pain is accompanied by nausea, fever, or frequent urination.|
|The child has lower back pain that increases on performing physical activity.|
|The child has back pain that wakes them up at night.|
Source: American Academy of Pediatrics
Prevention Of Back Pain In Children
Most often, back pain can be prevented by following certain preventive measures (4).
- Choose safe strollers, prams, and beds for young children to reduce the risk of falls.
- Encourage them to stretch and exercise regularly.
- Limit the time children sit in front of the television or computer.
- Teach children to develop good posture.
- Ensure they do not carry extremely heavy backpacks. According to the American Academy of Pediatrics, backpacks should not be more than 10–20% of the child’s body weight (8).
Back pain is not a serious problem in most children and can be resolved with physical therapy and over-the-counter medicines. However, getting your child evaluated by a specialist is recommended as early treatment can reduce complications and enable your child to lead an active and pain-free life.
- Poor posture, obesity, weak muscles, and a sedentary lifestyle are significant causes of back pain in children.
- Spondylolysis, spondylolisthesis, spinal cord tumors, and other medical problems can also cause back pain in children.
- It can be effectively treated with a consistent exercise regimen, increased physical activity, and alternative therapies such as acupuncture.
Peter et al. (2020). The Epidemiology of Back Pain in American Children and Adolescents.
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