Back Pain
Back pain in children is relatively uncommon. Usually, the child with back pain presents with a muscular strain-type pattern related to poor posture, activities at school or home, or other recreational or sporting pursuits (6).
When carrying backpacks of greater than 10% to 20% the body weight of the child or adolescent, musculoskeletal strain is common. Children and adolescents generally do well with strategies such as decreasing backpack weight, making sure the backpack is level to their shoulders, carrying the backpack on both shoulders, and using proper body mechanics when picking up items from the ground. With prompt adherence to these guidelines, only a small percentage of children and adolescents go on to have chronic symptomatology. Conservative intervention with physical therapy, correction of biomechanics, postures, equipment, and sporting environment are often all that is required for resolution of symptoms. NSAIDs along with the RICE protocol are utilized as well. Back pain that is not improving within two to four weeks of conservative care needs to investigated in a much more serious manner. Unlike the adult, chronic back pain in children can be met with serious pathologic entities, including neoplasm, infection, and noninfectious inflammatory disease (11). A full discussion of back pain in children is beyond the scope of this text, and the reader is referred to other sources (6,11,206). As mentioned previously in the text, backpacks are being utilized more often in children and adolescents, particularly to and from school and other recreational environments.Referred Back Pain
Many conditions can produce referred back pain. These include pyelonephritis, pneumonia, endocarditis, cholecystitis, pancreatitis, osteomyelitis, pelvic inflammatory disease, and other more general conditions affecting the muscles, as well as conditions such as inflammatory arthritis. Sickle cell pain crisis can cause back pain. Conditions that usually have the presenting complaint of nighttime pain are osteoid osteoma, a benign bone tumor that is the most common neoplasm, and ankylosing spondylitis. For malignant neoplasms of the spine, 90% are secondary sites and not primary tumors. Functional pain issues also present the clinical challenge of ruling out underlying, more serious disease. A good history and physical exam often points out inconsistencies.