Child and Adolescent Clinic - Chronic Back Pain in Children

Ask Dr. Sue

CHRONIC BACK PAIN IN CHILDREN

Dear Dr. Sue,

My 14 year old daughter complains of her back hurting a lot. And then her friends bring up that their backs hurt too. I'm not sure whether to worry or not. Aren't they too young to
have their backs hurting already? Does she need to go to the doctor?

Worried

Dear Worried,

It does seem like more children and adolescents are suffering from back pain. We used to believe that if a child had back pain, a specific physical cause would be detectable in most of them.
However, a recent study at Shriners in Spokane showed that 57% of children with back pain for more than two months had no specific cause found after a very thorough evaluation. We still take ongoing back pain very seriously, however, and I do think your daughter should be seen by a pediatrician to determine whether she needs further studies or follow-up.

Why do more children seem to have back pain lately? One cause is felt to be the heavy backpacks that many of them carry day after day. Another possible cause is a relatively inactive lifestyle,
with many hours spent hunched (with poor posture) in front of the TV, computer, and/or Nintendo. On the other hand, extremely athletic children that might overdo in sports such as gymnastics
or diving are also at risk for back pain.

Her back pain could be a sign of a physical problem if any of the following are associated with it:

Symptoms from elsewhere in the body, including fever, weight loss, nausea, vomiting, diarrhea or cough.
Pain that wakes her up from sleep.
She stops favorite activities because of it.
Persistently worsening pain.
Worse with menstruation or urination.
Pain has lasted longer than 3 or 4 weeks, even if it occurs off and on; or constant pain for three days without relief.
If she was preschool age rather than teenage.
She had any kind of significant fall or injury preceding the pain.

Pain that acts up with activity but stops with rest is more likely to be simply due to muscle overuse or strain and not a serious problem. Scoliosis, or curvature of the back, by the way, almost never causes ongoing back pain itself, but both the pain and the curvature could be caused by something else, so watching for the above symptoms would still be important.

The following are things you can do to prevent back pain related to carrying a backpack:

1. Make sure your child wears the backpack on both shoulders.

2. Convince her never to carry anything in it that isn't absolutely necessary, even if it means a trip to her locker between classes.

3. Don't let her carry a pack that is heavier than 20% of her body weight.

4. Use a backpack with wide, padded straps and preferable with a hip strap (like backpackers use).

5. Tighten the straps so that the pack rests 2 inches above the waist, and keep the heaviest items higher, closer to her back than her waist.

6. Ask your pediatrician for back-strengthening exercises.

7. Teach your child to bend with both knees when picking up the pack, or anything else that's heavy.

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