Back pain in children and teenagers
This page is provided by Thomas J. A. Lehman MD
Lehman is the author of many textbook chapters and articles on the care of
children and young adults with rheumatic diseases. He practices in
Delivering the best care - with great care
Back pain in children may be caused by a variety of different conditions. Often a brief episode of back pain is nothing more than a minor ‘strain’ associated with athletic activities or carrying a heavy backpack, but back pain which is severe or doesn’t go away in a few days needs to be investigated. Obvious injuries with pain or difficulty walking should always be evaluated immediately.
When evaluating a child without an obvious injury, the first thing to consider is the age of the child. Young children (under the age of 10 years) rarely complain of back pain. Any child in this age group with a complaint that ‘seems real’ should be evaluated by a physician. Infections in the bones, muscles, or other tissues of the trunk may be first described as back pain. These need to be promptly recognized and treated. Some childhood tumors may also begin with back pain. Many of these are minor conditions but some are serious. This is why any young child with back pain needs to be evaluated carefully.
Older children (age 10 and up) are more likely to have mechanical complaints. These can be associated with carrying a heavy back pack, sports activities, or structural abnormalities. There are a number of key questions to consider. Did the pain begin suddenly or has it come on slowly over a few days, or over a few weeks? Does the pain occur only in the afternoon, only in the morning when the child wakes up, or at anytime? Does the pain last a few seconds, minutes, or several hours? Does the pain wake the child up from sleep? Is the pain relieved by rest or does the child ‘stiffen up’ if he or she sits for a long car ride or in a movie theater? Are there certain positions which make the child feel better, worse? Is the pain in one spot, or all over? All of these are important questions that will help your doctor to better evaluate and diagnose your child’s condition.
Orthopedic causes of chronic back pain include injuries and mechanical problems such as Scheurmann’s disease, spondylolisthesis, spondylolysis, scoliosis, and osteoid osteomas. Most of the mechanical conditions are recognized because they cause pain with activities. The exceptions are scoliosis which is often painless and osteoid osteomas which may cause pain at night. All of these conditions can usually be diagnosed by physical examination, x-rays, and sometimes a bone scan. Infections causing back pain are usually quite dramatic. Bone scan or x-ray will almost always point to the diagnosis.
In some children chronic back pain is the first sign of enthesitis associated arthritis (see the page on spondyloarthropathies). The key is that these children frequently complain of being very stiff when the first wake up in the morning and often are described as ‘walking like a really old person’ when they get out of the car after a long car ride. Often this has come on slowly and the children and their families simply accept this as ‘normal.’ It isn’t. If your child is stiff when they wake up in the morning they need to be evaluated by a knowledgeable physician. Don’t let the condition be ‘explained away.’ I have seen many children who have given up on sports and other activities because of back pain who were easily restored to full function. The key is a careful evaluation and proper recognition of the cause of the back pain.
Common causes of chronic back pain in childhood
These require immediate attention
If your child is having back pain, ‘walks funny,’ or has difficulty moving around when they first get up in the morning make sure they have been carefully evaluated by their physician.
A more detailed description of these conditions may be found in my book below.
It’s not just
A guide to childhood muscle, bone, and joint pain,
rheumatic diseases and the latest treatments
Thomas J. A.
Oxford Press 2004
Click here to order
“Dr. Tom Lehman’s experience and compassion are evident on every page of this book, and they help guide the reader—child, parent, and healthcare professional alike – through the world of childhood arthritis. This book is an absolute gem written with a single goal in mind: improve the lives of kids with arthritis.” -- Jack Klippel, M.D. President and CEO of the Arthritis Foundation
“Dr. Lehman has given parents and families of children with
arthritis the first book that speaks to the parent and child as equals. His book explains the illnesses, the
medications, the lab tests, and the disease course in simple, understandable
lay language and givens them valuable insight into how a pediatric
rheumatologist thinks. Bravo!”-- Charles Spencer, M.D.,
Professor of Clinical Pediatrics,
"A must have for any family with a child who has a rheumatic disease! I personally found this book to very informative. Dr. Lehman, as always, gives families a clear understanding of their choice of treatments and what they can expect from their child's rheumatic disease."—Kathy Gaither, Juvenile Scleroderma Network, Inc.
"This comprehensive guidebook is a must-read for pediatricians and health care professionals who treat children and adolescents. For parents of children who have already been diagnosed with rheumatic disease, as well as children who have baffling, undiagnosed symptoms, this book will be a valuable resource."—Enid Engelhard, CSW, Director of Social Services, S.L.E. Foundation, Inc.
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