Unlike in adults, back pain in children is a significant cause for concern and is more likely to indicate an underlying disorder. More serious causes of back pain need early identification and treatment or they may become worse.
Symptoms
The following are factors that indicate the symptoms of pain in a child might not be that of a simple back pain:
- Duration of back pain. If pain persists for more than 4 weeks, it is important to look further into the cause of the prolonged pain.
- Character of back pain. If the pain is persistent, and bad enough to interfere with the child’s activities, it should be looked into.
- A history of unexplained fever, weight loss, or malaise should raise the suspicion of a systemic condition (affecting the whole body). Recent bacterial or viral infections should be let known to the doctor.
- Back pain that radiates down either or both legs should be taken more seriously.
- Age. Back pain in children younger than 4 years of age should warrant further investigation. Back pain in older children tend to be muscle strain from sports, and should go away with rest by one or two weeks.
- History of significant trauma will need X-rays to rule out fractures or dislocations.
- Night pain if constantly present should be investigated.
Causes
There are many causes of back pain in children, some more common in certain age group than others.
- Musculoskeletal
- overuse, muscle strain
- should resolve in less than 2 weeks with rest
- Spondylolysis and spondylolisthesis
- most common cause of back pain in adolescence especially in athletes
- caused by upper vertebral segment slipping forward on the lower segment
- Scheuermann’s kyphosis
- cause of back pain in a third of young children
- condition of the thoracic spine in adolescents where there is excessive curvature of the spine resulting in severe round back deformity
- Infection
- Discitis – infection of disc between bones of spine
- Vertebral Osteomyelitis – infection of bones of spine
- associated with sudden onset fever or previous viral or bacterial infection
- Trauma
- disc herniation
- apophyseal ring fracture
- crushed fracture
- Tumours
- rare in all age groups
- Juvenile rheumatoid arthritis, Ankylosing spondylitis
- inflammatory conditions caused by body’s own immune system
- Spinal Cord Abnormalities
- Idiopathic Juvenile Osteoporosis
- uncommon, usually affects children under the age of 10
Risk Factors
Read the causes of back pain for more information on the risk factors.
Children are at increased risk for some of the rarer forms of back pain if there is a family history.
Investigations
If there are concerning features about the back pain in the child, the doctor will perform the following tests:
- Blood test – reflects any infection or abnormal processes going on in the body
- X-ray of the spine & pelvis – to pick up any fractures
- Bone scan – more sensitive than a plain X-ray to detect any active infection or tumour of the bone
- MRI or magnetic resonance imaging – an accurate way to recreate an image of a part of the body to better look at any abnormalities around that area
- CT scan or computerised axial tomography – specialised X-ray test that allows for 3D imaging of the skeleton
Complications
If not treated, musculoskeletal causes of back pain will resolve. In more severe cases, the child will continue to suffer from back pain into adulthood.
For the more dangerous causes of back pain in children such as infection and tumour, there is the risk of progression and permanent back deformity and even death.
Treatment
Treatment varies depending on the cause of the back pain.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
For musculoskeletal causes of back pain, check out backpack safety.
F.A.Q. | Frequently Asked Questions
References
Ginsburg, G. & Bassett, G (1997) Back Pain in Children and Adolescents: Evaluation and Differential Diagnosis, Journal of American Academy of Orthopaedic Surgeons, Vol. 5, pp 67 – 78.