Pediatric Care

Back pain is a relatively common presenting symptom in children and adolescents, and most of it is musculoskeletal and benign in its course. It is rarely seen before school age; rates then rise through childhood until, by 18, the prevalence is much the same as an adult’s.^{[1, 2]}

What it could be is not what it could be in an adult. The typical causes named in the family medicine review are muscle strain or spasm, spinal deformities such as Scheuermann kyphosis and adolescent idiopathic scoliosis, spondylolysis, bulging or herniated discs, apophysitis of the iliac crest, and functional pain syndromes such as fibromyalgia. Spondyloarthropathies including ankylosing spondylitis can present as low back pain and stiffness, often worse in the morning. Malignancy and infection are less common and more serious.^[1]

Individual causes are most often overuse or trauma, and sinister ones are rare — but the differential is broad and it is different, which is the reviewers’ own reason for asking that the history and the physical examination be the foundation of evaluating a child with back pain.^[2]

That examination has published content: postural inspection, checking for tenderness, range of motion, strength testing, and testing for fractures and nerve impingement. Where the history and examination suggest underlying pathology, radiography and laboratory studies come first, and MRI, CT or a bone scan may follow.^[1]

Most of these children can be looked after by a general pediatrician, with orthopedic, rheumatologic and other subspecialty referrals considered where they are indicated.^[2]

Overuse is the commonest thread running through musculoskeletal back pain in this age group, which puts a seriously training teenager in two literatures at once rather than one.^[2]

What the trials found about preventing training injuries, and what deciding to go back actually involves, is on the sports page. Sports and athletic injuries