Back pain in kids and teenagers

……..Oooch my back hurts Mom

There is a myth that we don’t get back pain till we grow and most of us think it is a disease of tired bone. In contrast kids and teenagers do get back pain. Many studies had shown that nearly half percentage of school going children are prone to have a sore back.

Because of the myth that back pain is very rare in children it is often over looked and labelled as growing pains. In fact, back pain in children needs even more careful evaluation and warrants examination by a specialist as chances of serious pathology is much more common in children than that in middle aged people. 

Kids are least prone to put stresses on their back than the teenagers or adults and are less prone to Mechanical Back ache.  On the other hand, teenagers who tend to be more aggressive in their activities, sports testing the limits of their bodies commonly get mechanical back symptoms. 

What are the causes of back pain in kids and teenagers?

Developmental:

Spinal defects like minor defects in the vertebrae (spondylolysis), gross defects in some cases of spina bifida may cause back pain.

Mechanical:

Back pain caused by placing abnormal stress and strain on muscles of the vertebral column. The most common causes are poor posture, heavy school bags, poorly-designed seating, incorrect bending and lifting motions, exercises (not doing enough or over doing) and obesity.

Trauma or injury:

Often due to repetitive minor injuries like in sports or one major fall or accident.

Infection:

It is one of the causes in both kids and teenagers. Even though it is less common nowadays due to better nutrition, it is still a major problem. When the child is suffering from fever associated with sudden or repetitive back ache, swelling over the back, failure to thrive in kids, weakness in one or the other limbs suggest the possibility of infection in spine.

Tumours: 

Any abnormal growing mass from the soft tissue, bone or nerves in the spinal column can cause back pain both in kids and teenagers.

Deformity:

Scoliosis and kyphosis are the 3 dimensional deformities of the spine. Unless they are gross they often get missed till late. This is because generally they are not associated with significant pain contrary to one’s expectations.

Miscellaneous:

Growing aches and pains are more common in teenagers than in kids and to be dealt accordingly.

Management:

If a child is suffering from back pain regularly appropriate management should be initiated. The threshold to investigate is much lower in kids as the chances of a serious pathology is higher in kids compared to the adults. But when pain seems to be due to mechanical reasons, attention to ergonomics in the school and avoidance of some sports etc are important. Now a days the problem is getting compounded due to obesity in children. Appropriate exercises to suit the individual child and swimming are always beneficial.

Red flag signs

•  Patient under 20 years of age, more worrying under 4 yrs

•  Symptoms persisting beyond 4 weeks

•  Generally unwell,  weight loss, failure to thrive

•  Sudden pain & swelling  on the back, with fever

•  Night sweats

•  Pain worse at night or over thoracic / whole spine

•  Unsteady feet, numbness or pins / needle sensation of limbs

•  New curvature/bends of the spine with pain

•  Children on immuno suppression

•  Trauma / injuries to back