Peer Reviewed
Feature Article Paediatrics
Back pain in children and adolescents
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Back pain
Back pain
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Child development
Child development
Abstract
The causes of back pain in childhood and adolescence vary from the trivial to the life threatening. A thorough history and examination – along with the use of appropriate investigations – will elucidate the cause in most situations.
Key Points
- Discerning innocent from evil back pain requires a thorough history and examination of the patient, along with appropriate investigations.
- Back pain that is wakening patients from sleep, interfering with normal activities, or worsening should generate concern.
- Bed wetting in a previously continent child requires early and comprehensive investigation.
- Every child with back pain that cannot confidently be classified as innocent should have, at least, standing anterior–posterior and lateral radiographs of the spine.
- Reassurance, physiotherapy and a fitness program are effective for idiopathic back pain, with review after a few months of treatment.
- Disc herniation tends to occur in teenagers, but has been reported in children as young as 5 years.
- Discitis is characterised by delayed diagnosis. Initial signs may be nonspecific and early plain radiographs may be normal.
- Although rare, tumours should always be considered in children or adolescents presenting with back pain.
- Early specialist referral is warranted in cases of infection, tumour, spondylolisthesis and neurological abnormality. It is also indicated if the diagnosis remains obscure or symptoms persist.
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