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Quick reference medical handouts used by Pediatric offices


Back Pain in Children


Back pain, especially chronic back pain, is uncommon in children. However, when a child does complain of a backache, they are more likely than an adult to have a serious problem causing their discomfort.  Therefore, children with back pain should be seen by their doctor, especially if there was no injury or the pain is not improving after a few days.  Other warning signs are a child four years old or younger with back pain, or a child of any age who has back pain and:
  • Fever or weight loss
  • Weakness, numbness, trouble walking or pain that radiates down one or both legs
  • Bowel or bladder dysfunction
  • Pain that interferes with sleep
  • Pain that is constant or present at rest

Things that predispose children to developing back pain include:  

  • Gender, since back pain is more common in females.
  • Age, since children at 12 years and over experience significantly more back pain than younger children.
  • Obesity and poor posture.
  • Heavy schoolbags carried on one shoulder or in one hand.
  • Incorrectly packed backpacks.
  • Sedentary lifestyle, such as watching a lot of television or sitting in front of the computer.
  • Injuries caused by vigorous sports like football or horse riding, flexibility dependent sports such as gymnastics or dance, and power sports such as weightlifting or rowing.
  • Soft tissue injuries, such as strains and sprains.

Parents would be wise to see a doctor when their youngster complains of back pain. The most common cause of back pain in children is a sports injury, which can cause a muscle pull or ligament strain.  The pain can be treated with anti-inflammatory medicines, such as ibuprofen, rest, and ice. Improvement should be noted in five to seven days.  

Other medical causes of back pain include:

  • Spondylolysis: this is a frequent cause of back pain, occurring in almost 5% of children. It is caused by a defect in the lower vertebra of the spinal column. The pain is usually worse with activity and improves after a rest period. Treatment for mild cases involves limiting the activities that make the pain worse, while more severe cases may require bracing and rarely surgery. Some children with this condition may not have any symptoms.
  • Spondylolisthesis: some children with spondylolysis develop a forward slippage of their 5th vertebra with their sacrum. Mild cases require observation only, but more severe cases may require surgery.
  • Disk herniation: this is a rare cause of back pain in children, but a herniated disk may cause back pain and numbness or weakness. Treatment is usually with bed rest and rarely surgery for severe cases.
  • Diskitis: this is an infection of the disk space and can cause fever, back pain, irritability (especially in younger children), muscle spasms in the back and it may cause some children to hold their spine straight and/or refuse to stand or walk. The infection may also cause changes on an x-ray (narrowing of the disk space). A bone scan or MRI may need to be done to confirm the diagnosis, especially early in the infection when x-rays may be normal. Treatment is with bed rest a long course of antibiotics (controversial, and some studies suggest you may get better without antibiotics).
  • Pyelonephritis: this is a kidney infection that can cause back or flank pain. Children will usually have a sharp pain on one side of their back, fever, nausea, and pain or burning with urination. You should call you doctor immediately if you suspect your child has this infection.
  • Scheurman's kyphosis: a growth disorder of the vertebrae seen most commonly in adolescent males which may produce a humpback curvature (kyphosis)  Moderate to severe cases may require bracing, but mild cases usually require no treatment.
  • Fibromyalgia - although more common in adults, this nuisance chronic pain disorder does occur in adolescents, causing back and neck pain with associated muscle spasm and fatigue.
  • Sciatica - pain radiating down the buttock and leg, caused by compression of the sciatic nerve.
  • Idiopathic scoliosis - sideways curvature of the spine with an unknown cause; it is usually not painful. Any persistent pain associated with a fixed curvature must be carefully evaluated.
  • Tumors On rare occasion, tumors can be responsible for back pain. Spinal tumors usually happen in the middle or lower back. Pain is constant and progressive; it is unrelated to activity and/or happens at night
  • Infection of the Bone (osteomyelitis) 

The doctor may use one or several diagnostic tools in order to diagnose the cause of the child's back pain. These include:
  • X-ray. The doctor may take several X-ray pictures of the spine and pelvis from various angles.
  • Bone scan. More sensitive than X-rays, bone scans use a substance the doctor injects into a vein to detect infections, tumors and fractures with a special camera.
  • CT scan. Specialized X-rays that show a three-dimensional image, computed tomography (CT) scans let the doctor see bone injuries more clearly.
  • MRI. Magnetic resonance imaging (MRI) scans use radio waves to let the doctor see the spinal cord, nerve roots, disks or other soft tissues.


Suggestions to reduce the chance your child might develop back pain include: 

  • Give your child a backpack to carry schoolbooks. Make sure the backpack is worn correctly over both shoulders, and that the heavier items are packed close to the child's back.
  • Encourage regular 'walking and stretching' breaks when doing homework because sitting for long periods of time can fatigue back muscles.
  • Limit television and computer time.
  • Teach them how to sit properly in a chair - for example, instead of slouching, they should sit up straight with their bottom square on the seat.
  • Make sure their lifestyle includes plenty of exercise.
  • Encourage your child to warm up and cool down thoroughly when exercising to reduce the risk of injury.
  • Use proper sporting techniques and appropriate safety equipment (such as helmets and padding).
  • Suggest a regular program of gentle stretching to help prevent tight muscles.
  • Make sure you look after your back too - children learn best by example.


posted 08-13-04 on kidsgrowth.com

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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