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Causes of back pain in a child

By Miss Sally Tennant, consultant paediatric orthopaedic surgeon from Chiswick Medical Centre, part of HCA Healthcare UK.


Most parents do not expect otherwise healthy children to suffer from back pain and in most cases, back pain is not a sign of a serious underlying problem. Muscular back pain does occur in children, as in adults, and can be seen after sporting injuries, growth, carrying heavy bags, poor posture, and be associated with poor core muscle strength. In some cases, however, back pain in children can be a sign of a more serious underlying disorder, requiring accurate diagnosis and treatment, so it is important to establish the difference between some minor pains and something more serious.


As a consultant orthopaedic surgeon, I specialise in paediatrics and see children daily with different back conditions and complaints. This is an overview of the common signs and symptoms of back pain in children, how you can help, and when to see a specialist.

How do you know when a child's back pain is serious?

Worrying features of back pain in children include pain that is very focal and localised to one particular area of the back, rather than generalised back pain. As with any source of pain in children, pain that is persistently interfering with activities such as play in younger children and sport in older children, is concerning. Other concerning features include:


  • night back pain, particularly if it wakes a child from sleep
  • systemic symptoms such as loss of appetite, loss of weight, fever, night sweats, and tiredness
  • pain which is more apparent in the morning on first getting out of bed, and which is associated with stiffness
  • pain associated with any visible deformity of the spine
  • back pain associated with leg pain or spasm.


Any of these back-pain symptoms should be urgently assed by a medical professional.

What would cause back pain in a child?

Causes of back pain are different in children than in adults, for example, herniated discs and other degenerative conditions are rare in children. Below are some of the most common causes of back pain in children:


  1. Generalised muscle ache and sporting injuries
    Simple back pain following a sporting or other injury should settle quickly. Over the counter medicine such as paracetamol and anti-inflammatory medication can be helpful in the short-term. If there has been underlying rapid growth spurts resulting in tight muscles elsewhere, eg., the hamstrings, a physiotherapist can be particularly useful by advising stretching programs. Physiotherapy exercises are also very useful in improving core muscle strength. Physiotherapists are often a good first step in the treatment of back pain, but it is helpful to see a paediatric physiotherapist who has experience of dealing with children and the problems experienced during skeletal growth. They will frequently advise onward referral if they have any concerns about a specific underlying cause of back pain.
  2. What is spondylolysis?
    This condition is a repetitive strain type injury which produces a small stress fracture in part of the bone of the lumbar vertebral column. This type of stress fracture most commonly occurs in young people who take part in sports involving repetitive hyperextension, such as gymnastics and diving. If this occurs on both sides of the spinal column, it may produce some gradual movement of the vertebral bodies above the stress fractures, and is then called a spondylolisthesis. A spondylolysis produces persistent localised pain in the lower back, with hamstring spasm. This can make continuing sporting activities is difficult. Diagnosis is made with a high index of suspicion and nowadays with a CT scan, possibly also with an MRI which can help differentiate between an acute and a chronic, healing fracture.

    Although this diagnosis sounds concerning, it does not mean that the spine is unstable and is not an acute emergency. The treatment recommended is usually rest and physiotherapy. Surgery is not often required. The diagnosis usually needs to be made by an orthopaedic surgeon and sometimes require onward referral to a spinal surgeon.
  3. Spinal infection
    In rare circumstances back pain in children can be a sign of an infection of the bone or disc in the spine. Symptoms include generalised back pain, fever and feeling unwell. If your child complains of back pain with a fever, you should seek medical advice immediately. Blood tests and an MRI scan will usually confirm the diagnosis.
  4. Spinal tumour
    Similar to infection, tumours of the spine are very rare, but can cause back pain. They are most often benign tumours. They are often in the middle or lower back and the symptoms of spinal tumours are pain which is constant and gets progressively worse over time. Night pain may interrupt sleep. MRI and CT scans will be used in diagnosis.
  5. Inflammatory arthritis
    While children do not suffer from degenerative arthritis (osteoarthritis) like adults do, they can develop inflammatory (rheumatoid like) arthritis, of which there are several types. This may be associated with lower back pain, with or without other joint involvement. Sometimes there are also systemic symptoms as well as anaemia. Inflammatory pain is typically associated with stiffness which is worse in the morning, in comparison with mechanical back pain which is worse after activity and towards the end of the day. Investigations will include blood tests and an MRI scan, with onward referral to a paediatric rheumatologist.
  6. Spinal deformity
    Children occasionally develop a scoliosis, which is a curve in the back, and may be noticeable as an asymmetry in the height of the shoulders, or the pelvic bones. Occasionally this is what we call positional, secondary to a difference in the leg lengths, or to carrying a heavy bag on one shoulder for a long period of time.

    Structural, or fixed, curves are actually caused by a rotation in the spinal column, which secondarily causes a curve. These curves occur gradually and get worse with skeletal growth. They are rarely present at birth and may be due to a malformation of one of the vertebral bodies in the spine. More commonly they become apparent during the adolescent growth spurt, particularly in girls. This is then caused idiopathic adolescent scoliosis. It is often first detected when parents notice a change in the shape of the child’s back. Muscular back-ache is a common complaint associated with a scoliosis. This type of deformity gets worse as growth progresses, and it is helpful to see a specialist as soon as deformity is recognised.

When should you seek medical attention for back pain?

In summary, if your child is experiencing back pain it is unlikely to be anything serious and may settle quickly with rest. Some symptoms and signs may suggest a more sinister cause that requires a medical consultation:


  1. persistent and chronic pain
  2. pain and stiffness which is much worse in the morning
  3. pain which interferes with play, and other activities
  4. night pain and rest pain
  5. fever, night sweats, weight loss and other constitutional symptoms
  6. neurological symptoms including leg pain, weakness, numbness.


If you are worried about back pain in your child, it is best to speak to a specialist consultant. Doctors at the Chiswick Medical Centre will gladly examine your child and provide reassurance.


Sally Tennant is based at the Chiswick Medical Centre, part of HCA Healthcare UK For appointments and more information see 020 8131 6232

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