Back pain in children
and teenagers
This page is provided by Thomas J. A. Lehman MD
Dr.
Lehman is the author of many textbook chapters and articles on the care of
children and young adults with rheumatic diseases. He practices in New York City. Click here for more information about Dr. Lehman or the Hospital for
Special Surgery.
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
Injury
Infection
Tumors
These require immediate attention
Scheurmann’s
disease
Spondylolisthesis
Spondylolysis
Spondyloarthropathies
Scoliosis
Osteoid osteoma
Kyphosis
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.
The information provided here is excerpted from
at Amazon.com
It’s not just
growing pains.
A guide to childhood muscle, bone, and joint pain,
rheumatic diseases and the latest treatments
Thomas J. A.
Lehman
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, University
of Chicago, La Rabida
"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.
Click
here to order from Amazon