Health & Fitness

Keeping Kids Fit: Back pain is becoming an increasingly common complaint in children

Is your child’s backpack hurting his or her back? Is that heavy bag causing your teenager’s scoliosis? Can bad posture cause back pain? These are common questions from parents as we see our kids come and go to school with their many books and supplies.

In the past, back pain was an uncommon complaint in children. However, the complaint has increased over time and now we see that back pain affects up to 50 percent of children by the time they are 20 years old.

Most back pain in children is muscular pain, such as sprains and strains. This type of pain is often related to overuse or poor mechanics and usually involves the muscles surrounding the spine. It can worsen with twisting or heavy lifting. Other potential contributors include very soft mattresses; inadequate sports equipment, such as poorly cushioned sports shoes or incorrectly positioned bike seats; and obesity. Lastly, it is also important to consider depression, anxiety and other psychosocial concerns that can manifest with muscular back pain.

Initial treatment for muscular back pain includes:

▪ Pain medication. Acetaminophen and Ibuprofen may help pain caused by muscle strain, sprain or overuse.

▪ Heat therapy. Heat can help in the first few days if the injury is due to overuse. Be careful to avoid burns.

▪ Physical activity. Staying active helps relieve muscle spasms and prevent muscle weakening.

▪ Avoiding high impact activities if pain is related to overexertion. Low impact activities such as walking, biking and swimming help.

▪ Stretching and strengthening exercises. Sometimes formal physical therapy is also needed.

Not all back pain is muscular. Spondylolysis is the most common non-muscular cause of low back pain in children and adolescents. In spondylolysis, repetitive extension of the spine leads to a fracture of one of the lower vertebrae. Activities associated with this condition include ballet, gymnastics, football, high jumping, diving, rowing and weight lifting. Spondylolysis requires evaluation by a physician and sometimes further evaluation by a sports medicine specialist.

Postural “roundback” is a common cause of forward bending of the spine. The condition is usually associated with a growth spurt and is a normal variant. Back pain associated with this condition may be related to activity or occur after prolonged sitting. Physical therapy to strengthen muscles is used to treat this condition.

If interventions do not help relieve your child’s pain, he or she should be seen by a physician. There are several other causes of back pain that require evaluation and treatment. Some red flags that should prompt medical attention include:

▪ Severe pain that occurs at night, wakes the child from sleep or worsens over time.

▪ Pain accompanied by fever or weight loss.

▪ Back pain in a child under 5 years of age.

▪ Leg weakness, limping or refusing to walk.

▪ Pain that developed after a recent injury.

▪ Past history of cancer or tuberculosis.

▪ Change in bladder or bowel habits.

▪ Pain that prevents the child from participating in normal activities.

When you arrive at the pediatrician’s office, you can expect the physician to perform a thorough medical history and physical exam. It is not always necessary to obtain X-rays or blood tests.

What about backpacks? There has been much discussion about whether heavy backpacks have been contributing to our kids’ back pain and ailments.

Evidence linking back pain with backpack weight is inconclusive. While some studies have shown a correlation between backpack weight and pain, others have found no association between the two. The American Academy of Pediatrics recommends that backpacks weigh less than 10-20 percent of body weight. Other measures to decrease backpack-related pain include using rolling backpacks or keeping a second set of books at home.

While backpacks may be associated with back pain, they do not cause abnormalities in the spine such as scoliosis. In addition, carrying backpacks unevenly does not lead to abnormalities of the spine. Idiopathic scoliosis is an abnormal lateral (sideways) curve of the spine. The condition develops in teenagers and can progress until the skeleton is mature. It is found in two to three percent of the general population. The cause is unknown, although there may be a genetic component to the condition. Typically, scoliosis does not cause back pain. Severe scoliosis may require involvement of a specialist.

Remember, make sure your child’s backpack weighs less than 10-20 percent of his or her body weight. Be sure your children are using appropriate sports equipment. Be aware of pain that can be related to overuse. Keep in mind the possibility of depression and anxiety. If a child has any of the red flags listed, seek medical attention.

Sujata Tipnis is a pediatrician at UHealth – University of Miami Health System. For more information, visit