Back pain affects children and adolescents, causing concern for parents. Though often temporary and benign, pediatric back pain should never be automatically considered “normal.” It warrants attention and monitoring because a small percentage of cases can indicate a serious underlying condition requiring prompt medical evaluation.
Understanding Back Pain Prevalence in Children
Back pain is a common complaint in school-aged children, with prevalence rates rising significantly as they enter adolescence. Studies show that between 28% and 48% of school-aged children experience back pain, with incidence increasing linearly from ages 10 to 18. Among adolescents, the lifetime prevalence of low back pain can reach up to 70%. Females report back pain more frequently than males, and the lower back is the most common site of discomfort.
Back pain in a child under the age of 10 should be treated with caution, as younger patients are more likely to have a serious underlying disorder. The majority of episodes are short-lived, often resolving with rest, suggesting a musculoskeletal origin. However, persistent or severe pain should not be ignored, as back pain can be a predictor of chronic pain in adulthood.
Common Mechanical Causes of Aches
The most frequent source of back pain is mechanical, stemming from muscle strain, soft tissue injury, or overuse. Sports and physical activities are major contributors. Repetitive motions, twisting, and hyperextension can strain the muscles and ligaments supporting the spine. Young athletes in high-impact sports like gymnastics, diving, or football are particularly susceptible. This muscular pain is usually localized, worsening with activity and improving with rest.
Poor posture, especially prolonged slouching while sitting or looking at a screen, puts unnatural stress on the spine and its supporting musculature. This sustained, incorrect positioning overstretches ligaments and weakens core muscles, leading to chronic low-grade backaches. Strengthening the abdominal muscles and stretching tight hamstrings are often recommended to alleviate this imbalance and provide better spinal support.
Another common mechanical factor is the use of heavy or improperly worn backpacks. A backpack that is too heavy, or carried over only one shoulder, forces the child to compensate by altering their posture and gait. This constant adjustment places undue strain on the back and shoulder muscles, which can lead to fatigue and pain. They are a known factor in causing transient muscular aches.
Warning Signs that Require Medical Evaluation
While most back pain is non-serious, certain “red flag” symptoms indicate the need for immediate medical assessment to rule out a severe underlying cause. A quick diagnosis is paramount if any of the following are present:
- Pain that is constant, progressive, or severe enough to limit daily activities.
- Nocturnal pain that wakes the child from sleep, as this is rarely a simple muscle strain.
- Systemic symptoms, including unexplained fever, chills, or unintentional weight loss.
- Neurological symptoms, such as numbness, tingling, or weakness radiating down the legs.
- A change in bowel or bladder function, or difficulty walking (change in gait), signaling a potential emergency involving the spinal cord or nerves.
- Back pain in a child under the age of four, or persistent pain lasting longer than four weeks.
Serious Conditions Affecting the Growing Spine
Spondylolysis and Spondylolisthesis
Less common but more serious causes of back pain involve structural or infectious conditions affecting the developing spine. Spondylolysis is a stress fracture in a specific part of the vertebra, most often in the lower spine. It is common in young athletes whose sports involve repetitive back extension. If this fracture is bilateral, the vertebra can slip forward onto the bone below it, a condition called spondylolisthesis. This slippage can compress nerve roots, causing lower back stiffness, muscle tightness, and sometimes leg symptoms.
Scheuermann’s Kyphosis
Another structural abnormality is Scheuermann’s Kyphosis, which involves an increased forward rounding of the upper or middle back. This occurs when the front sections of the vertebrae grow slower than the back sections, causing them to become wedge-shaped. The resulting hunched appearance can cause chronic pain in the middle of the back that worsens with activity.
Other Structural and Infectious Causes
Scoliosis, a lateral curvature of the spine, is a well-known spinal condition, though it is often painless. If scoliosis is accompanied by back pain, it may indicate a more complex underlying issue, such as a disc herniation or spondylolysis. Though rare, infections of the spine, such as discitis (infection of the disc space), typically affect younger children and are serious. They present with severe pain, often accompanied by fever, requiring immediate diagnosis and treatment.