From the Guidelines
Treatment for low back pain in children should begin with conservative measures, including rest, gentle stretching, and over-the-counter pain medications, with imaging reserved for cases with red flags, as recommended by the American College of Radiology 1. The initial approach to managing low back pain in children typically involves a combination of rest, gentle stretching, and over-the-counter pain medications such as acetaminophen (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) or ibuprofen (10 mg/kg every 6-8 hours with food) to help manage pain and inflammation 1. Some key points to consider in the management of low back pain in children include:
- Physical therapy focusing on core strengthening exercises and proper posture is often beneficial, with sessions 2-3 times weekly for 4-6 weeks.
- Heat therapy using warm compresses for 15-20 minutes several times daily can relax muscles, while cold packs may reduce inflammation during acute pain.
- Most pediatric back pain resolves within 1-2 weeks with these approaches.
- If pain persists beyond 4-6 weeks, worsens, or is accompanied by fever, weight loss, neurological symptoms, or nighttime pain, medical evaluation is necessary to rule out serious conditions like infection, tumor, or structural abnormalities 1.
- Children's back pain differs from adults' as it more commonly has identifiable causes rather than being mechanical, making proper assessment crucial.
- Maintaining healthy weight, proper backpack use (weighing less than 10-15% of body weight), and regular physical activity can help prevent recurrence. Imaging, such as spine radiographs or MRI, is recommended only in the presence of red flags, including constant pain, night pain, radicular pain, pain lasting more than 4 weeks, or abnormal neurologic examination 1.
From the Research
Treatment Approaches for Low Back Pain in Children
- Physical, psychological, and pharmacological interventions are effective in reducing pain intensity and disability in children and adolescents with low back pain 2
- Interdisciplinary and patient- and family-centered treatment approaches are the gold standard for persistent pain in children and adolescents 2
- Communication between health professionals, children, and parents is a key part of a therapeutic alliance 2
Physiotherapy Interventions
- Physiotherapy interventions, such as exercise, postural hygiene, and physical activity, are effective in improving back care and preventing non-specific low back pain in children and adolescents 3
- The evidence for physiotherapy interventions is of very low to moderate quality, but interventions involving physical exercise, postural hygiene, and physical activity are preferred 3
Diagnostic Approaches
- A diagnostic approach for children presenting with low back pain to the emergency department should include identifying high-risk factors (red flags) associated with severe prognosis conditions 4
- The presence of red flags is more significant in children with severe prognosis conditions, and these children are more likely to be hospitalized 4
Imaging Techniques
- Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain, but computed tomography (CT) can be used as an alternative in some cases 5
- CT shows high values of sensitivity and specificity in most of the items evaluated, but sensitivity is low for the evaluation of density of the disc and for the detection of disc herniation 5
Treatment Considerations
- Treatment approaches should be tailored to the individual child's needs, taking into account factors such as age, gender, and family structure 2
- A multidisciplinary approach to treatment, including multimodal medical, psychological, physical, and interventional approaches, is most effective for chronic back pain patients 6