Child Back Pain

Children can experience back pain in much the same way as adults. The difference, however, is that it's more common for a child with a backache to have a serious underlying disorder. This is almost always the case with a child under the age of 4 if her pain occurs in conjunction with difficulty walking, fever or weight loss, leg pain, weakness or numbness, bladder or bowel problems, or pain that keeps her awake at night.

Medical History

• Your pediatrician or health-care provider will need to know everything about the child's health, including information about any medical conditions and diseases, previous accidents, a family history of disease, the location of the pain and the time at which it first surfaced. He will ask if the ache moves through the legs, is accompanied by weakness, tingling or numbness, and if it occurs at night. He will also want to determine any difficulty with bowel movements or urination and whether movement makes the pain worse or better.

Physical Exam

• The doctor will examine the child's bones, muscles and nerves. On the spine, she will look for deformities, mobility and alignment, feeling each vertebra. She will test the legs and back to determine the function, tightness and size of the relevant muscles. The child will be asked to walk so the doctor can look at his gait. He will also be asked to touch his toes and extend and bend in various directions. With the child lying on his back, the doctor will raise his legs to test the nerves in his back. She will also examine muscle tenderness, spasms, reflexes, flexibility and coordination.

Tests

• The doctor may use imaging and other tests to assess the cause of the back pain, including X-rays of the pelvis and spine. A CT scan shows a three-dimensional image so the doctor can determine if there are any bone injuries. Bone scans detect fractures, infections and tumors. An MRI will provide the doctor with a clear image of the spinal cord, disks, nerve roots and soft tissues. He may also schedule a blood test to check red and white blood cell counts.

Muscle Strains

• Most children with back pain have some sort of musculoskeletal strain. The condition usually improves through a regimen of exercise, rest and anti-inflammatory medications. There are more serious conditions, however, including rounded back, or Scheuermann's kyphosis, which causes pain in the middle of the back, or thoracic spine. Vertebrae are wedged, which results in a hunched or rounded back. The pain may worsen during sports or other activity. Boys are more susceptible to Scheuermann's kyphosis than girls and usually develop it between 14 and 17 years of age. Treatment doesn't usually require surgery, and the doctor may prescribe a brace to flatten the curve, a series of casts or exercises to strengthen the back.

Other Injuries

• A stress fracture, or spondylolysis, may also cause back pain in children, more commonly girls. The fracture can develop while playing sports like football or gymnastics or during growth spurts. The pain is usually mild and may travel to the legs and buttocks. It worsens during physical activity and feels better with rest. The child may have a stiff-legged gait when walking. Depending on the severity, treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), rest, strengthening exercises for abdominal and back muscles, braces or surgery.

  Sometimes, spondylolysis can cause slipped vertebrae. At the base of the spine, one vertebra moves forward on the next vertebra. The bone can narrow the spinal canal and press against nerves. Treatment includes a restriction on physical activity, monitoring and surgery.