By Max W. Cohen, MD, FAAOS, of Spine & Scoliosis Specialists

Older people aren’t the only ones who can experience pain in their backs. Children and adolescents also can experience back pain that can affect their activity level and quality of life. 

Back pain is the most common problem worldwide. Generally, it occurs in adults, elderly people and pregnant women. As compared to the adults, back pain is observed to a less extent in teenagers and children due to their spine flexibility. Back pain is more evident in teenagers or adolescents of age group 18-20 years. Incidence of back pain in teens or children has been growing of late. In most cases, it is not a serious problem since back pain results from muscle or ligament injury without any structural changes. However, when the pain occurs in children under 10 years old and is persistent while interfering with daily activities, then it is a serious issue which requires immediate medical attention.

Every parent whose child is complaining of back pain worries that a more serious problem may be occurring. 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. 

Some of the warning signs to look out for more serious problems include:
• Night pain (especially pain that awakens your child from sleep)
• Constant symptoms of pain
• Symptoms of generalized illness (fever, chills, weight loss)
• Symptoms persisting beyond several weeks
• Symptoms in very young children
• Leg pain, numbness, or weakness

These warning signs don’t necessarily mean there is a more serious problem; however, they are a good screening test to determine if more evaluation should be pursued. 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.

Importantly, pediatricians are also starting to see a new form of injury in school-age children and teens become more common: overuse injuries and back strain caused by carrying back packs that are too heavy. Often, backpacks may equal 20% to 40% of the child’s own body weight (equivalent to a 150-pound adult carrying a 30 to 60-pound back pack around 5 days a week). This amount of weight understandably creates a great deal of strain on the child’s spine. Additional strain that may cause back pain comes from children and teens carrying their backpacks over one shoulder, causing an uneven load on the spine.

Back pain in children and adolescents is not unusual and becoming more common over time. Part of this is due to changes in activities of children, and part is due to changes in conditioning of children. If your child is having back pain, especially if it is associated with the warning signs mentioned, it is worthwhile to have him or her seen by your doctor. Initiating the proper treatment, and ensuring the symptoms are improving, can help to ensure this problem does not persist. If the symptoms are worrisome or unusual, further evaluation may be necessary to ensure a more unusual cause of the pain is not present. The good news, for kids and parents alike, is the vast majority of children with complaints of back pain find relief that tends to be lasting. While back pain can interfere with sports and other activities, with the appropriate treatment program, these children almost always return to full activities without ongoing problems of back discomfort.

Back Conditions That Affect Children and Teens

• Pain that is made worse by specific movements, such
as handsprings in gymnastics, the butterfly stroke
in swimming, or contact sports, may be caused by
spondylolysis or spondylolisthesis. Young athletes with
low back pain have a higher-than-average incidence
of spondylolysis. These injuries are usually caused by
activity and overuse.
• Scheuermann’s disease causes pain that is not severe
enough to limit activity. It is the second most common
cause of back pain in children and young adults. Your
child may have a rounded spine.
• A child who is awakened at night by pain may have an
infection, arthritis, or tumor of the spine.
• Back pain that is present with changes in balance or
coordination may be caused by a problem in the brain
or spinal cord.

Max W. Cohen, MD, FAAOS, the founding physician of Spine & Scoliosis Specialists, is the
only doctor in the Triad with double fellowship training in spine and scoliosis surgery. He has treated tens of thousands of patients
and performed thousands of surgeries since he began practicing in 2002. He completed his training at Cornell University’s prestigious
Hospital for Special Surgery, the top-ranked orthopaedics hospital in the U.S., according to U.S. News & World Report.