Back pain is a common complaint in children and adolescents, and can be a source of worry for caregivers. Fortunately, as in adults, the majority of back pain in children is not related to a serious underlying condition. There are, however, certain red flags that parents should be aware of which signal that back pain could be a sign of a more dangerous problem.
When a child presents to me with back pain, one of the first questions I have is whether the pain is worse during the daytime or at night. Usually, the pain will get worse during the daytime, when the child is active. Pain that gets worse at night is concerning for a less common cause of back pain, such as an infection or tumor.
Patients with spinal infections will often have a history of a recent infection elsewhere in the body, as well as symptoms such as fatigue, fevers or chills. Most pediatric spine infections will resolve with a course of antibiotics.
Growing-age children can also develop tumors of both the spinal cord and the bones of the spine. While most pediatric spine tumors are benign, they can sometimes cause significant pain. Tumors can also present with other symptoms beyond back pain, such as fatigue, weight loss, weakness, or numbness in the legs. The treatment of a spinal tumor will depend on which particular tumor is found, but in all cases, early diagnosis is essential.
Another important question that I have when a child presents with back pain is whether there has been any recent trauma. Spine fractures are rare in children, but they can occur with car accidents or falls from height. When there has been a history of trauma, we will often obtain imaging to investigate whether a fracture has occurred. Most spine fractures in children can be treated without surgery, although they may require a period of rest from sports activities.
Another type of spine fracture that can cause back pain in children is a condition called spondylolysis (Greek for “break in the bone”). As opposed to an acute fracture that results from trauma, spondylolysis is a chronic stress fracture of the bone that results from overuse. This condition is frequently seen in athletes that have to extend their back for their sport, such as football players, dancers and gymnasts. In most cases, spondylolysis can be treated with rest, physical therapy, and occasionally bracing. Most athletes are able to return to their sport.
Disc herniations are less common in kids than in adults, but we do occasionally see adolescent patients with pain related to a disc herniation. The symptoms can include both back and leg pain. Treatment options include physical therapy, over-the-counter pain medications, and epidural steroid injections. In most cases, the pain will get better on its own over time. Surgery is an option for patients who have persistent pain after over a year of conservative management.
One question that parents frequently have is whether imaging is necessary in the evaluation of back pain. The decision of whether imaging is necessary depends on the child’s history and physical exam. While arriving at a correct diagnosis is essential, unnecessary imaging can lead to increased cost and radiation exposure. Your doctor will be able to guide you as to what imaging is needed.
Another common question is whether backpack use is associated with back pain in kids. There have been some studies that have shown a link between both backpack weight and time of use and increased pain in children. In general, the weight of the backpack should not exceed 15% of the weight of the child. Certain schools will allow accommodations for children with back pain to use a rolling backpack or have a set of books at home.
When a child develops back pain, it can be a source of anxiety for caregivers. While most back pain is not dangerous, that should not be assumed to be the case until the conditions listed above have been ruled out. Be on the lookout for red flags such as recent trauma, pain at night, and pain, weakness, or numbness that extends into the legs. Mention these symptoms to your doctor if your child experiences them. It is important to have your child evaluated by a doctor with experience in seeing kids with back pain.
Childhood is too short to spend it in pain.