Back pain in children

Introduction
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By Bhagwan Moorjani MD

Although it has been widely believed that back pain in children and adolescents is rare, recent evidence suggests that back pain is experienced by a considerable number of children and adolescents, but only a few are seen by the medical practitioner. The main challenge in differential diagnosis and the workup of pediatric back pain is identifying the “red flag” symptoms and signs to target investigations for those children with underlying pathology. In this clinical summary, Dr. Ofek provides epidemiologic data as well as a useful approach to this challenging symptom. The use of imaging modalities in pediatric back pain and management are likewise discussed.

Key points

  • Back pain in children is more common than previously thought, affecting around 25%, with incidence rates higher among female adolescents.
  • A thorough history and physical examination is important to guide the clinician to select the patients who needed investigation and the type of diagnostic modality to perform.
  • Age, lifestyle, psychological, and social factors are given due consideration in the assessment of children and adolescents with back pain so as not to miss serious underlying pathology or over-investigate those with nonspecific musculoskeletal causes.
  • “Red flag” symptoms must be sought to rule out pathology in children, and any identified must be investigated.
  • MRI is a useful imaging modality.
  • Rehabilitation with physical therapy and back education programs are the mainstay of treatment.