Back pain in children

Back pain is common in children, particularly during adolescence. Some causes of back pain in young people include poor posture, unsuitable forms of exercise and carrying heavy schoolbags.

If your child’s back pain persists, and is felt in the same place, take your child to see a doctor.

Why back pain happens in children#

Children with back pain may become adults with chronic back problems, so it is important to encourage sensible back care early. While a single incident can cause a sudden spinal injury, ongoing, nagging back pain is usually caused by a range of factors working together.

Relatively minor injuries during normal sports and games may lead to muscle spasm, so that some back muscles have to work harder than others. This can cause fatigue, pain and changes in posture, and poor posture can in turn make back pain worse.

A child with a sore back may avoid sport, and the resulting lack of exercise can then cause further problems. Many things can contribute to back pain in children, including:

• a sedentary lifestyle, such as watching a lot of television or sitting for long periods at a computer
• injuries from vigorous sports such as football or horse riding
• flexibility-dependent sports such as gymnastics or dance
• power sports such as weightlifting or rowing
• competitive sports that demand intense training; for example, tight thigh muscles can trigger lower back pain

Always see your doctor for diagnosis if your child complains of ongoing back pain, particularly if it wakes them at night or comes with long periods of stiffness in the morning.

Medical conditions that can cause back pain#

Soft tissue injuries, such as strains and sprains, are the most likely cause. In some cases, though, the pain is caused by medical conditions that need professional treatment. These can include:

• injuries to bones and joints, such as compression fractures
• disc injuries, which are rare in children
• fibromyalgia, a chronic pain disorder that is more common in adults but does occur in adolescents, causing back and neck pain with muscle spasm and fatigue
• sciatica, pain radiating down the buttock and leg caused by compression of the sciatic nerve, which is rare in children
• Scheuermann’s disease, a growth disorder of the vertebrae in adolescents that may produce a humpback curvature (kyphosis)
• idiopathic scoliosis, a sideways curvature of the spine with an unknown cause, which is usually not painful, although any persistent pain with a fixed curvature must be carefully investigated
• spondylosis, a structural defect in the vertebrae; certain activities, such as hyperextending the spine in gymnastics, may increase the potential for pain

Back pain and schoolbags#

A heavy bag slung over one shoulder can, over many years of schooling, cause chronic back problems that linger into adulthood. Risks include muscle strain, distortion of the natural ‘S’ curve of the spine and rounding of the shoulders.

Schoolbag-related risk factors for back pain include:

• a bag that weighs more than 10 per cent of the child’s body weight
• an incorrectly fitted backpack
• holding the bag in one hand by its straps
• carrying the bag over one shoulder
• an incorrectly packed backpack

Parents and carers can reduce these risks by making sure their child has an appropriately sized backpack with a load that is not too heavy.

Buy the right kind of backpack#

Your child should use a backpack rather than a traditional schoolbag with handles. When choosing one:

• Make sure the backpack is appropriate to your child’s size; do not buy the biggest one you can find.
• Choose a backpack with a moulded frame or adjustable hip strap, so the weight rests on your child’s pelvis rather than their shoulders and spine.
• Make sure the shoulder straps are adjustable and the rear of the backpack is padded for comfort.
• Look for a backpack with a few separate compartments to help with packing.
• Choose a lighter material, such as canvas, over a heavier one such as leather.
• Take your child with you when buying the backpack, so you can check that it fits and that they like it. (If the style is unappealing to them, your child may carry the backpack in a way that is bad for their back, such as over one shoulder.)

Using a bag with wheels rather than a backpack may also help avoid or reduce ongoing back pain.

Pack the backpack correctly#

• Make sure the packed backpack weighs less than 10 per cent of your child’s body weight. For example, a child weighing 40 kg should carry less than 4 kg, and ideally only around 2-3 kg of books.
• If your child is expected to carry more than this, discuss with the school whether it is necessary. If so, ask about keeping a second set of books at home or using electronic versions.
• Pack the heaviest items closest to the child’s back. Items packed further away throw out the child’s centre of gravity and cause unnecessary strain.
• Make sure items can’t move around during transit, and use the backpack’s compartments.

Correct lifting and carrying#

To reduce your child’s risk of injury when using a backpack:

• Adjust the shoulder straps so the bottom of the backpack sits just above the child’s waist; don’t let them wear it slung low over their buttocks.
• Make sure the backpack is fitted correctly, following the shape of the child’s back rather than hanging off the shoulders.
• Teach your child to slip an arm through one shoulder strap and then the other.
• Teach them to lift the backpack with a straight back, using their thigh muscles, and to hold it close to their body with both hands.
• Check whether the child has to lean over to carry the load. If so, the backpack is too heavy, incorrectly fitted or wrongly packed.
• Make sure your child understands that carrying the backpack over one shoulder can cause back pain and injury.

Preventing back pain in children#

Other ways to reduce spinal stress include:

• Reduce the risk of falls for younger children by always using safety straps in prams, strollers and on change tables.
• Spread a soft material, such as tanbark, around home playground equipment to cushion falls.
• Encourage regular walking and stretching breaks during homework, because sitting for long periods can fatigue the back muscles.
• Limit television and computer time.
• Teach your child to sit properly: instead of slouching, sitting up straight with their bottom square on the seat. An ergonomic chair can help with posture during homework.
• Make sure their lifestyle includes plenty of exercise, and stress the importance of straight posture and regular stretching for strong back and core muscles.

Back pain tends to become more common with age, with children of 12 years and over reporting significantly more back pain than younger children, and is more common in girls. Obesity and poor posture, heavy schoolbags carried on one shoulder or in one hand, incorrectly packed backpacks and soft tissue injuries are all contributing factors.

Key points#

• Back pain is common in children, particularly during adolescence.
• Muscle spasm and overworked back muscles can cause fatigue, pain and changes in posture.
• A child with a sore back may avoid sport, and the lack of exercise may then cause further problems.
• Heavy schoolbags risk muscle strain, distortion of the natural ‘S’ curve of the spine and rounding of the shoulders.
• Schoolbag-related risk factors include an incorrectly fitted or incorrectly packed backpack.

Where to get help#