5 Common Causes of Back Pain In Children, Symptoms, Treatment

Back pain in kids has become a common complaint. A study in 2019 noted that out of the 1,236 pediatric participants, 34% reported back pain, while 9% reported severe back pain (1). Most cases of back pain in children may usually resolve with the help of physical therapy. However, it is safe to consult a pediatrician, especially if the child is younger than five years.

Keep reading to know more about the causes, symptoms, diagnosis, treatment, and prevention of back pain among children.

Is It Normal For Children To Have Back Pain?

Back pain was considered uncommon in children; however, recent studies suggest that by 15 years of age, 20–70% of children will complain about back pain at some point (2).

That said, short-term back pain might not indicate any underlying issue (2). Nevertheless, if children complain of persistent pain in a particular area or if their pain is accompanied by fever and weight loss, it needs to be addressed at the earliest (3).

Causes And Risk Factors For Back Pain In Children

Back pain among children is not always problematic.

Most cases of back pain occur due to muscular strain, commonly in the lower back. Wrong exercise techniques and injuries could also contribute to the pain (2).

Some common causes and risk factors for back pain in children include (1) (4)

• Poor posture
• Gender—back pain is more common in girls than boys
• Age—children aged 12 years and above are more prone to back pain than younger children
• Obesity
• Weak and stiff back muscles
• Weak core muscles
• Sedentary lifestyle
• Improperly packed heavy backpacks
• Sports that require rigorous practice, such as gymnastics, football, horse riding, and rowing

Some medical conditions responsible for back pain in children may include (4) (5)

1. Spinal stress fracture (spondylolysis): This condition mostly affects the lower back and generally occurs in growing children who are active in sports such as gymnastics and diving. It could also be a result of growth spurts.

2. Slipped vertebrae (spondylolisthesis): This condition is often a complication of spondylolysis and is caused when a vertebra, mostly in the lower part of the spine, moves over the vertebra below it. In severe cases, the bone presses on the nerves.

3. Rounded back (Scheuermann’s kyphosis): This skeletal deformity gives a hump-like curvature to the spine. This condition is caused by a growth disorder of the vertebrae.

4. Infection: Often, back pain occurs due to infection in the disk space (e.g. Pott’s Disease). This condition is more common in younger children and is characterized by lower back pain, stiffness of the spine, or difficulty bending.

5. Spinal cord tumor: Spinal cord tumors in children are rare, but when they occur, they can cause severe back pain. The pain aggravates with time and does not diminish with rest. Tumors mostly appear in the middle and lower back and require immediate medical attention.

Symptoms Of Back Pain In Children

The symptoms of back pain may vary among children depending on the underlying cause. However, some of the common symptoms include (6)

• Pain with movement
• Pain after prolonged sitting
• Muscle spasms
• Stiff back muscles
• Painful muscles around the spine

When Should You Worry About Your Child’s Back Pain?

Often, back pain in children is not serious. However, it is important to watch out for the following severe symptoms, which require medical intervention (5) (6).

• Chronic pain that lasts longer than four weeks
• Pain extending to the legs and causing weakness or numbness
• Night pains that hamper sleep
• Chronic pain that disrupts normal activities
• Back pain accompanied by fever or night sweats
• Weight loss
• Pain accompanied by changes in bowel or bladder habits
• Chronic pain that does not reduce with rest

Diagnosis Of Back Pain In Children

Although most cases of back pain improve with conservative treatment options, such as physical therapy, it is recommended to consult a pediatric spine specialist to avoid serious complications.

Specialists examine children by doing physical checks and studying their general health. Hence, preparing the answers to the following questions would help the pediatric spine specialist accurately determine the nature of the back pain (7).

• How old is the child?
• Is the constant pain inhibiting the child from participating in normal activities?
• Can the child walk properly and bend with ease?
• Where is the pain located, and how long or intense are the episodes?
• Is the pain accompanied by fever or chills?
• Has the child lost weight?
• How is the appearance of the child’s back (check the curvature or if there are any unusual features)?
• Is the pain causing numbness or tingling in any part of the body?
• Is the pain alleviated with non-steroidal anti-inflammatory drugs, such as ibuprofen?

This general information will help the healthcare provider detect any unusual physical findings and determine whether further tests, such as the following, are required (7) (8).

1. Radiograph: Radiographic findings are useful for identifying non-muscular back pains, such as those caused by vertebral fractures.

2. Magnetic resonance imaging (MRI): An MRI is suggested for patients who have experienced back pain for more than six weeks. Such pain is likely to be related to an infection or other serious conditions.

3. Computerized tomography (CT) scan: A CT scan enables doctors to understand the bone structure after a fracture, infection, or spinal tumor.

4. Bone scan: A bone scan creates images of the bones and helps diagnose different bone diseases.

5. Laboratory tests: Laboratory tests are mostly recommended when the back pain is related to an infection or inflammation. The recommended blood tests are complete blood count, erythrocyte sedimentation rate, and C-reactive protein measurement. In the case of suspected tuberculosis, a tuberculin skin test (TST) or purified protein derivative (PPD) test can be requested.

Treatments For Back Pain In Children

Typically, children do not require complicated treatments or surgery for back pain and can instead opt for the following treatment options (6).

• Following a consistent exercise program for around six to eight weeks
• Doing activities such as yoga, cycling, swimming, or Pilates to strengthen the back and abdominal muscles
• Alternative treatments like acupuncture, massage, and chiropractic care

The following table illustrates the causes and necessary treatment options for several back-related concerns in children (9).

Source: American Academy of Pediatrics

Prevention Of Back Pain In Children

Most often, back pain can be prevented by following certain preventive measures (4).

• Choose safe strollers, prams, and beds for young children to reduce the risk of falls.
• Encourage them to stretch and exercise regularly.
• Limit the time children sit in front of the television or computer.
• Teach children to develop good posture.
• Ensure they do not carry extremely heavy backpacks. According to the American Academy of Pediatrics, backpacks should not be more than 10–20% of the child’s body weight (8).

References

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Reviewer

Maria Carmela Villania-MamauagMD, DPPS

 

Maria Carmela Villania-Mamauag is a board certified diplomate of the Philippine Pediatric Society with a degree of Doctor of Medicine from Our Lady of Fatima University, Valenzuela City and a Bachelor in Science in Psychology from Saint Louis University, Baguio City which was augmented by a year of Bachelor in Science in Family Life and Child development at the University of the Philippines, Diliman, Quezon City.

Read full bio of Maria Carmela Villania-Mamauag