Patient education: Back pain in children and adolescents (Beyond the Basics)
- Peter A Nigrovic, MD
Peter A Nigrovic, MD
- Associate Professor of Medicine
- Harvard Medical School
BACK PAIN OVERVIEW
Back pain occurs commonly in children and adolescents, affecting up to 50 percent of children by age 18 to 20 years. The pain may be sharp and shooting, burning, or aching, and may be felt anywhere in the back.
Although back pain may be a sign of a more concerning problem, especially in children younger than 10 years, most episodes of back pain in children are not serious and resolve without treatment.
This topic will review the most common causes of back pain in children, treatments that can be tried at home, and a guide to when the child should see his or her healthcare provider. Back pain in adults is discussed separately. (See "Patient education: Low back pain in adults (Beyond the Basics)".)
BACK PAIN CAUSES
The most common cause of low back pain in children is muscle sprain and strain. This can occur while playing, from carrying a heavy backpack, or after a fall.
Less common causes include abnormalities in the spinal bones (vertebrae), infections, arthritis, and, rarely, cancer. (See "Back pain in children and adolescents: Causes".)
WHEN TO SEEK HELP
Contact your child's healthcare provider if your child has one or more of the following:
●Back pain that is severe, occurs at night or wakes the child from sleep, or worsens over time
●Back pain accompanied by fever (temperature >100.4ºF or 38ºC)
●Back pain accompanied by weight loss
●Back pain in a child under five years of age
●Leg weakness, walking with a limp, or refusing to walk
●Back pain that developed after a recent injury
●Past history of cancer or tuberculosis
●Change in bowel or bladder control (eg, new accidents)
●Back pain that prevents the child from participating in normal activities
●Back pain that is accompanied by morning stiffness lasting more than 30 minutes
BACK PAIN DIAGNOSIS
To determine the most likely cause of a child's back pain, the healthcare provider will ask questions and will perform a physical examination. Blood tests and x-rays or other imaging tests are not always needed, especially if the back pain began recently. (See "Evaluation of the child with back pain".)
BACK PAIN TREATMENT
If your child has back pain but has none of the warning signs described above (see 'When to seek help' above), it is reasonable to try some home treatments initially. However, if the child's pain does not improve, call the child's healthcare provider.
Pain medications — Non-prescription pain medications, such as acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin) may help to reduce a child's back pain. These medications are particularly helpful for back pain caused by overuse, strains, and sprains.
These medications should be given according to the child's weight, rather than age.
Heat — Applying heat can help with back pain during the first few days after overuse or an injury. You may use a heating pad, hot water bottle, or other hot pack. Be careful to avoid burning the skin with a pack or pad that is too hot.
Remaining active — Staying active can help to relieve muscle spasms and prevents weakening of the muscles. On the other hand, back pain caused by overexertion may not improve without rest. Thus, high-impact activities (running, jumping, or other activities that cause pain) should be avoided while the child has pain. It is fine for the child to continue with regular day-to-day activities and light exercise that does not cause pain.
Bed rest is not recommended. Children who prefer to remain completely inactive should be evaluated by a healthcare provider.
Stretching and strengthening exercises — As the pain begins to improve, your child's healthcare provider may recommend specific stretching and strengthening exercises. A physical therapist can help to design a program tailored to your child.
Activities such as walking, swimming, bicycling, and other low-impact activities are also recommended. The child should temporarily avoid activities that involve twisting or bending, are high impact, or that make the back hurt more.
WHERE TO GET MORE INFORMATION
Your child's healthcare provider is the best source of information for questions and concerns related to your child's medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Approach to the child with a limp
Back pain in children and adolescents: Causes
Adolescent idiopathic scoliosis: Clinical features, evaluation, and diagnosis
Evaluation of the child with back pain
Overview of the causes of limp in children
Spondyloarthritis in children
Adolescent idiopathic scoliosis: Management and prognosis
The following organizations also provide reliable health information.
●American Academy of Orthopaedic Surgeons
- Backpack safety. American Academy of Pediatrics. Available at: www.aap.org/publiced/BR_Backpack.htm (Accessed on March 30, 2009).
- Diepenmaat AC, van der Wal MF, de Vet HC, Hirasing RA. Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents. Pediatrics 2006; 117:412.
- Pellisé F, Balagué F, Rajmil L, et al. Prevalence of low back pain and its effect on health-related quality of life in adolescents. Arch Pediatr Adolesc Med 2009; 163:65.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.