What causes back pain in pediatric patients?

From the Guidelines

Back pain in pediatric patients is most commonly caused by mechanical factors, with risk factors including female gender, poor general health, high level of activity, backpack loads, and family history of back pain.

Common Causes of Back Pain

• Mechanical back pain is the most common cause, responding to conservative treatment with imaging not always required 1
• Other causes include traumatic, infectious, inflammatory, congenital, and neoplastic processes 1
• Spondylolysis, scoliosis, Scheuermann disease, and bone tumors can be diagnosed on radiographs 1

Diagnostic Approach

• A diagnostic algorithm is suggested for evaluation of children with back pain to reduce unnecessary examinations and radiation exposure 1
• Children with back pain of short duration, a normal physical examination, and minor or no history of trauma may not require further laboratory or imaging evaluation [1, @8@]
• Clinical and laboratory findings suggesting an infectious or neoplastic etiology should be imaged without delay, with MRI being a sensitive tool for evaluating soft tissue and bony abnormalities 1
• MRI without contrast can be an effective screening tool in evaluating pediatric patients with certain red-flag clinical presentations, including mechanical back pain and spondylolysis 1

From the Research

Causes of Back Pain in Pediatric Patients

• Back pain in pediatric patients can be caused by various factors, including:
  • Musculoskeletal issues such as muscle strain or spasm 2, 3, 4, 5
  • Spinal deformities like Scheuermann kyphosis or adolescent idiopathic scoliosis 3, 5
  • Spondylolysis or bulging/herniated intervertebral disks 3, 5
  • Apophysitis of the iliac crest or functional pain syndromes like fibromyalgia 5
  • Less common but more serious causes include malignancy, infections, or spondyloarthropathies like ankylosing spondylitis 3, 5

Evaluation and Diagnosis

• The evaluation of back pain in pediatric patients typically starts with a complete clinical history and examination 6, 3, 4, 5
• Imaging studies such as radiography, magnetic resonance imaging, or computed tomography may be performed to rule out underlying pathology 2, 6, 3, 5
• Laboratory studies like complete blood count, erythrocyte sedimentation rate, or C-reactive protein measurement may also be conducted to identify potential causes 3, 5

Factors Warranting Immediate Evaluation

• Certain factors may require immediate evaluation, including:
  • Patient age younger than four or five years 3, 5
  • Persistent symptoms or self-imposed activity limitations 3
  • Systemic symptoms, increasing discomfort, or persistent nighttime pain 3, 5
  • Neurologic symptoms like bowel incontinence, urinary retention, or other signs of nerve impingement 5