From the Research
The initial management for a 9-year-old patient with posterior neck pain and a negative X-ray should focus on conservative treatment, prioritizing rest, activity modification, and pain management with NSAIDs or acetaminophen, as most pediatric neck pain is musculoskeletal in nature and self-limiting 1. The goal of treatment is to reduce pain and inflammation, while maintaining gentle range of motion exercises to prevent stiffness.
- Administer weight-appropriate doses of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (10 mg/kg every 6-8 hours, not exceeding 600 mg per dose) or acetaminophen (15 mg/kg every 4-6 hours, maximum 5 doses in 24 hours) to reduce pain and inflammation.
- Apply ice for 15-20 minutes every 2-3 hours during the first 48-72 hours, then transition to heat therapy, as heat has been shown to increase blood flow and reduce pain 2.
- Physical therapy focusing on gentle stretching and strengthening exercises may be beneficial if pain persists beyond 1-2 weeks.
- Parents should monitor for red flag symptoms such as fever, progressive neurological symptoms, or worsening pain, which would warrant immediate reassessment. This conservative approach is supported by recent evidence, including a study published in 2023, which emphasizes the importance of careful history and physical examination to ascertain the etiology of neck pain and guide treatment 1. If symptoms persist beyond 2-3 weeks despite these measures, further imaging such as MRI may be considered to evaluate for less common causes.