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What You Need to Know: Your Child & Low Back Pain

Published September 19, 2017
| Written By SpineNation Editorial Staff  

Back pain is recognized as an origin of discomfort for adults, but can the same be true for a child? Can children become lower back pain patients? Despite the obvious observation that age-related wear and tear clearly cannot be the perpetrator of a child's possible condition, the answer is yes.

Unfortunately for our little buggers, lower back pain is being diagnosed more frequently in children and adolescents than in years prior. Specifically, 10-30 percent of the U.S. population each year reported that their kids experienced some form of back pain.

Dr. Jonathan Cluett, board-certified orthopedic surgeon in Williamstown, Massachusetts, explained, "Some of the reasons why back pain in kids may be so common include higher body weights of children and higher rates of obesity, higher intensity and year-round sports activities, and the increasing weight of backpacks worn by young students at school."

Most mothers and fathers probably don't anticipate their generally healthy children to experience back pain partially due to the fact that people generally correlate back pain to middle-aged or older individuals. Nevertheless, the truth is that back pain is pretty common in children and adolescents.

"Back pain is common in adults, and the majority of the time, it's nothing serious,” explained Dr. Vesna Martich Kriss, associate professor of radiology and pediatrics at the University of Kentucky College of Medicine, “But when children complain, doctors and parents should be concerned.”

Here, you can discover the knowledge about what causes his or her back pain, and when a closer look may be required, provided by Cluett.

Every parent whose son or daughter complains of back pain may be afraid that something more severe is ahead.

What Should I Look For?

"While there are certainly serious causes of back pain, the vast majority of kids with back pain have symptoms that result from muscle or ligament injury, without any structural abnormality," Dr. Cluett interjected.

Warning signs to watch out for that may indicate a more serious problem include:

  • Night pain (especially pain that awakens your child from sleep)
  • Constant symptoms of pain
  • Symptoms of generalized illness (fever, chills, malaise, weight loss)
  • Symptoms persisting beyond several weeks
  • Symptoms in very young children
  • Leg pain, numbness, or weakness

These warning signs don't inevitably determine there is a more pressing issue, however, they are a good screening comparison to use when deciding if further evaluation is necessary.

Cluett explained, "For example, muscular back pain can persist for months, however, if the symptoms have been going on for several weeks, it's best to ensure the diagnosis is clear."

Muscular Back Pain

About two-thirds of all children complain of back pain conclusively from muscular back pain.

Injuries like these include muscle strains, ligament strains (stemming from falling during soccer or dance class), overuse injuries (maybe from a heavy backpack), problems with posture (slouching all day at school), and poor conditioning of the muscles of the back (a combination of them all).

Usually, muscular back pain will heal with rest and modifications in activities, posture and maybe bookbag weight. Many remedies may only afford temporary relief, and while long-term consequences of treatments for children are controversial, they are generally safe. Those other treatments involve physical therapy, chiropractic care, a stretching program, yoga, or massage therapy.

Stress Fractures

Stress fractures can occur in the spine of any human being. Most often these stress fractures occur in adolescents who may never even recognize that an injury ever happened. Though, over time, symptoms of the fracture normally manifest.

The most obvious type of spinal stress fracture is spondylolysis, an injury to the backbone of the spinal column.

This injury is found most often in adolescents who are involved in sports where repetitive movements cause hyperextension (bending backward) of the spine, such as gymnasts and divers. If the stress fracture takes place on both sides of the spinal column, this can cause weakness of the spinal column and may turn into an alignment shift of the spine's vertebrae column.

People generally get nervous after this diagnosis due to the fact that these injuries normally don't heal, and they can manifest into adulthood. Nevertheless, the majority of children and adolescents with spondylolysis are treated nonsurgically and recover faster with less-invasive treatments. Surgery is reserved as a last resort.

Disc Problems

Even though a herniated disc is less common in children, it can still happen. When a disc herniates, the soft buffer between two vertebrae is broken. That disc material is then pushed out of its normal location and can press against the nerves including the spinal cord.

Symptoms of a disc herniation can include leg pain, numbness and tingling in the legs, weakness of the lower extremities, and difficulty bending or straightening the spine.

"In children, normal disc material is pliable and elastic — it has a much better ability to withstand unusual forces on the spine. As we age, the disc loses its elasticity and pliability and can become prone to rupture," Cluett emphasized.

Yet, even in the youth, discs can still rupture due to excessive force (traumatic injury) or an abnormal disc structure.

Oftentimes, disc herniations can be controlled without the need for surgery. Children with severe pain may benefit from a surgical procedure to alleviate stress on the nerve.


It can be difficult to diagnose infections of the spinal bone or discs. Because spinal infections may produce obscure symptoms that include depression, low-grade fevers, and generalized back pain.

The determination of a spinal infection is frequently done because of irregular laboratory readings that display signs of infection (elevated white blood cell count) or inflammation. If suspected, imaging tests would be performed to verify the location of the infection.

"Surgery is generally only considered if the infection has caused damage to the spinal structure or if the infection cannot be adequately controlled with the use of antibiotics," Cluett pointed out.

Alignment Abnormalities

Obstacles with the alignment of the spine can produce a striking deformity, which may be linked to the existence of back pain. The two most popular spinal deformities in children would be scoliosis and Scheuermann's kyphosis.

Scoliosis is a disfigurement that causes an S-shaped curve on the spine. Scheuermann's kyphosis induces a sharp bend in the spine when seen from the side.

These disorders are extremely different, however, the treatment sources are related.

In less critical deformities, observation leads the charge in deciding how to treat it. If the deformity advances, a back brace may be necessary. If the deformities get worse, surgery would then become an option. Even if surgery is on the table, the symptoms may linger since a full repair can actually cause additional problems other than a partial correction.


Several various benign and malignant bone tumors may take root in the spinal column. Sometimes these inflict notable pain, other times they can be detected without causing any symptoms.

Please note that while spinal tumors are very rare, they should still be considered as a possible, although unusual, diagnosis.

Some of the warning signs mentioned previously can be compared with tumors, especially the complaint of night pain, the complaint of generalized sickness or weight loss.

Treatment of spinal tumors depends on the particular class of tumor. Even benign (noncancerous) ones may necessitate surgery as sometimes untreated growths can contribute to a deformity of the spine. Cancerous tumors in the spine need a blend of treatments that may involve medications, radiation, or surgery.

In order to properly diagnosis a condition, you need to know what the problem is so you can fix it, which is where specialized imaging tests come into play.

How to Make the Diagnosis 

If nothing shows up on your child's imaging tests, their pain should not be ignored. When children complain of back pain, nearly a third of the time there's an actual problem, whether due to an injury, infection or a tumor.

"Even if an initial x-ray doesn't show anything, parents shouldn't stop there if pain persists," Kriss explained.

Young athletes and gymnasts, in particular, are prone to back injuries because they're normally competing at high levels, which can place additional stress on immature bones.

Kriss added, "Sometimes a fracture after a trauma doesn't show up in an x-ray for a week or two. A second x-ray may be necessary if the child continues to complain, and occasionally, a bone scan may be necessary to get to the root of the problem.”

Some imaging exams , such as x-rays, CT scans, and MRIs are not always the most effective at making a proper diagnosis. These exams are sometimes not needed unless you observe one or more of the warning signs mentioned above. 

As with any exam, there are negatives to redundant testing. One test can lead to another and before you know it, your child has been exposed to too much radiation.

All of this makes it very important to discuss all of your options with your doctor before action is taken.

Is There a Solution?

Simple precautions to take begin with checking your child's book bag before they leave for school. Speak with them about the importance of balance and how a heavy bag can hurt their back and spinal alignment. Get them a bag with wheels if you have a concern about the load they carry. If they walk home from school, consider arranging a carpool.

In addition, if your child is an athlete, speak to them about the importance of listening to their bodies. Guide them through basic back stretches before and after sports to help prevent injury and cool down muscles.

Try not to stress about your son or daughter's back pain. You want to gather all of the information from them and relay it to your pediatrician before action is taken. Talk to your child. Listen to them. Even if they protest about any modifications that would need to be taken in order to prevent further damage, let them know it's in their best interest. Get on their level. Sit down and have a mutual conversation. There's always a compromise out there, you just have to find it.

Updated: November 27, 2019

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