Back Pain in Children: Causes, Symptoms & When to See a Doctor

What Is Back Pain in Children and How Common Is It?

Back pain in children refers to discomfort in the thoracic (mid-back) or lumbar (lower back) spine. While uncommon in young children, it affects 20-30% of adolescents, particularly during puberty. Most pediatric back pain is benign and resolves within one week without specific treatment.

Back pain was once considered rare in children, but recent research shows it is more common than previously thought, especially in teenagers. The prevalence increases significantly during adolescence, when children experience rapid growth spurts and increased participation in sports and other physical activities. Studies show that by age 15, approximately one in three adolescents has experienced at least one episode of back pain.

Unlike adult back pain, which is often related to degenerative changes, work-related strain, or chronic conditions, back pain in children typically has different causes. The growing spine is more vulnerable to certain types of stress, but it also has remarkable healing capacity. Understanding the unique aspects of pediatric back pain helps parents and healthcare providers manage it appropriately.

The location of back pain in children is typically in one of two areas: the thoracic spine (middle back, between the shoulder blades) or the lumbar spine (lower back, above the buttocks). Lower back pain is somewhat more common in teenagers, while mid-back pain may be more prevalent in younger children. The location can sometimes provide clues about the underlying cause, though most cases remain benign regardless of location.

Why Does Back Pain Increase During Puberty?

During puberty, children undergo dramatic physical changes that can stress the developing spine. Growth spurts cause bones to lengthen rapidly, sometimes faster than the surrounding muscles and tendons can adapt. This mismatch between skeletal growth and soft tissue flexibility can lead to muscle strain, tightness, and pain. The spine may grow several centimeters in just a few months during peak growth velocity.

Additionally, puberty brings changes in body composition, posture, and activity levels. Adolescents may spend more time sitting for school, gaming, or social media use, often with poor posture. They may also begin more intensive sports training or weight lifting. These combined factors create a perfect storm for back discomfort, though fortunately, most cases are temporary and self-limiting.

When Should Parents Be Concerned?

While most back pain in children is harmless, certain features should prompt medical evaluation. Back pain in children under 10 years old is less common and more likely to have an identifiable cause that needs investigation. Pain that persists beyond a few weeks, interferes with daily activities, or is accompanied by other symptoms deserves professional assessment. The goal is to identify the small percentage of cases that may require specific treatment while reassuring families that most back pain is benign.

What Causes Back Pain in Children and Teenagers?

Most back pain in children has no identifiable cause and is related to muscular strain from growth, activity, or posture. Common causes include rapid growth during puberty, intensive sports training, heavy backpacks, prolonged sitting, and overuse injuries. Less commonly, scoliosis, disc problems, or inflammatory conditions may be responsible.

In the majority of cases, no specific structural cause for a child's back pain can be identified, even with imaging studies. This type of pain, called nonspecific or mechanical back pain, is thought to result from minor muscle strains, ligament sprains, or temporary imbalances in the growing musculoskeletal system. While frustrating for parents who want a definitive diagnosis, the good news is that nonspecific back pain almost always improves with time and conservative treatment.

Understanding the various factors that can contribute to pediatric back pain helps parents implement preventive strategies and appropriate management. The causes can be broadly categorized into growth-related factors, activity-related factors, and less common structural or medical conditions.

Growth-Related Causes

The rapid growth that occurs during puberty places unique stresses on the developing spine. During growth spurts, bones may temporarily outpace the surrounding muscles and tendons, creating tightness and vulnerability to strain. The hamstrings, hip flexors, and back muscles can become particularly tight during periods of rapid growth, contributing to back discomfort. This is why flexible children may suddenly become much less flexible during puberty.

Growth-related conditions like Scheuermann's disease, a form of kyphosis (rounding of the upper back) that develops during adolescence, can also cause back pain. In this condition, the vertebrae develop wedge-shaped, leading to increased curvature of the thoracic spine. While it can cause pain and postural changes, most cases are mild and managed conservatively with physical therapy and activity modification.

Activity-Related Causes

Both too much and too little activity can contribute to back pain in children. Sedentary behavior, particularly prolonged sitting with poor posture for school, homework, or screen time, weakens the core muscles that support the spine and can lead to muscle strain and discomfort. Modern children and teenagers spend more time sitting than previous generations, and this trend correlates with increasing rates of back pain.

On the other end of the spectrum, intensive athletic training, especially in sports that involve repetitive spinal loading, twisting, or hyperextension, can cause overuse injuries. Gymnastics, dance, swimming, football, rowing, and wrestling are examples of sports with higher rates of back problems in young athletes. The problem is often not the sport itself but rather training programs that are too intense, progress too rapidly, or lack adequate rest and recovery.

• Heavy Backpacks: Carrying backpacks exceeding 10-15% of body weight strains the spine and alters posture
• Poor Posture: Slouching while sitting, especially during screen time, stresses spinal structures
• Repetitive Movements: Sports requiring repeated twisting, bending, or extension can cause overuse
• Sudden Increase in Activity: Rapidly intensifying training without proper conditioning
• Inadequate Warm-up: Beginning vigorous activity without proper preparation

Structural and Medical Causes

While uncommon, certain structural abnormalities and medical conditions can cause back pain in children. Scoliosis, an abnormal lateral curvature of the spine, affects 2-3% of adolescents and may cause back pain in some cases, though many children with scoliosis have no pain. Spondylolysis, a stress fracture in the vertebral arch, occurs most commonly in adolescent athletes and causes lower back pain that worsens with activity. Disc herniation, while rare in children, can occur and may cause back pain with radiating leg symptoms.

Inflammatory conditions affecting the spine, such as juvenile ankylosing spondylitis or other spondyloarthropathies, can present with persistent back pain and stiffness, particularly in the morning. Infections of the spine (discitis or vertebral osteomyelitis) are rare but serious, typically causing constant pain with fever. Tumors affecting the spine are extremely rare in children but should be considered if pain is persistent, worsens at night, or is accompanied by unexplained weight loss or neurological symptoms.

What Are the Symptoms of Back Pain in Children?

Symptoms typically include pain in the middle or lower back that may worsen with activity, muscle stiffness, and limited range of motion. Pain usually lasts less than a week in benign cases. Warning signs requiring urgent evaluation include fever, night pain, neurological symptoms, or pain preventing normal activities.

The symptoms of back pain in children vary depending on the underlying cause and the child's age, but most cases present with relatively mild, localized discomfort. Understanding what constitutes normal, self-limiting pain versus symptoms that warrant concern helps parents respond appropriately and avoid both unnecessary anxiety and delayed treatment for serious conditions.

Children may describe their symptoms differently than adults, and younger children especially may have difficulty articulating the nature, location, and intensity of their pain. Parents may notice behavioral changes such as reluctance to participate in activities, changes in posture, or complaints during or after physical activities. Adolescents can usually describe their symptoms more precisely but may downplay pain to continue sports participation.

Common Symptom Patterns

The most common presentation is mild to moderate pain in the lower back or mid-back that comes and goes, often worsening with activity and improving with rest. The pain may be described as aching, stiff, or tight rather than sharp or severe. Children may notice the pain more at certain times, such as after sitting for long periods, after sports practice, or when carrying a heavy backpack. Morning stiffness is common but typically resolves within 30 minutes of getting up and moving.

Associated muscle tightness in the hamstrings, hip flexors, and back muscles is common, and children may have difficulty touching their toes or performing activities that require spinal flexibility. Some children experience muscle spasms, though these are usually mild. The pain typically affects the midline or both sides of the back equally; pain that is strictly one-sided may warrant additional evaluation.

Red Flag Symptoms Requiring Urgent Evaluation

While most back pain in children is benign, certain symptoms should prompt immediate medical evaluation. These "red flags" suggest the possibility of more serious underlying conditions that require prompt diagnosis and treatment. Parents should seek urgent care if their child experiences any of the following:

When Should I Take My Child to the Doctor for Back Pain?

Seek medical attention if your child's back pain prevents normal activities, recurs frequently, lasts more than a few weeks, or occurs with fever. Immediate care is needed for fever with back pain, leg weakness or numbness, or changes in bladder or bowel function.

Deciding when a child's back pain needs professional evaluation can be challenging for parents. The vast majority of episodes are harmless and will resolve on their own, but some situations warrant medical attention. Understanding which symptoms can be safely monitored at home versus which require prompt evaluation helps parents make appropriate decisions without either ignoring potentially serious problems or seeking unnecessary care for self-limiting conditions.

The general principle is that back pain in children that significantly impacts their daily life, persists beyond the typical timeframe for healing, or is accompanied by concerning features should be evaluated. The child's age is also important: back pain in children under 5 years old is unusual and always warrants investigation, while in adolescents, brief episodes related to activity are more common and less concerning.

Situations Requiring Non-Urgent Medical Evaluation

Schedule an appointment with your child's healthcare provider within a few days to weeks if your child experiences back pain that limits normal activities such as playing, sports, or school participation. If the pain returns frequently, even if each episode resolves, this pattern suggests an underlying issue that should be investigated. Pain lasting more than two to three weeks without improvement also warrants evaluation, even if it is not severe.

Children who develop back pain after starting a new sport or significantly increasing their training intensity should be evaluated if the pain persists despite reducing activity. Similarly, back pain associated with visible changes in posture or spinal alignment, such as one shoulder appearing higher than the other or the spine curving to one side, should be assessed for scoliosis or other structural conditions.

Situations Requiring Urgent Medical Evaluation

Certain combinations of symptoms require same-day or emergency evaluation. Back pain accompanied by fever is concerning for possible spinal infection, which is a medical emergency requiring prompt diagnosis and treatment. Neurological symptoms such as weakness in the legs, numbness or tingling, difficulty walking, or changes in bladder or bowel control may indicate spinal cord compression and require immediate attention.

Back pain following significant trauma, such as a fall from height, motor vehicle accident, or sports collision, should be evaluated promptly even if the child seems okay, as spinal fractures can occur without obvious external injury. Pain that is constant, severe, and unrelieved by rest or position changes is also concerning and warrants urgent evaluation.

How Is Back Pain in Children Diagnosed?

Diagnosis begins with a thorough history and physical examination by a doctor or physical therapist. This includes assessment of posture, range of motion, neurological function, and specific tests for scoliosis. X-rays may be ordered if symptoms persist. MRI is reserved for cases with red flag symptoms or suspected disc or soft tissue problems.

The diagnostic approach to pediatric back pain differs somewhat from that used in adults. Because serious underlying causes are less common in children but potentially more significant when present, healthcare providers must balance thorough evaluation against unnecessary testing. Most children with back pain will not require any imaging studies, as the history and physical examination provide sufficient information for diagnosis and treatment in the vast majority of cases.

The evaluation typically begins with the primary care provider but may involve referral to specialists such as pediatric orthopedists, sports medicine physicians, physical therapists, or in rare cases, pediatric rheumatologists or oncologists, depending on the findings. The goal is to identify the rare cases requiring specific intervention while providing appropriate reassurance and treatment for the common benign causes.

History and Physical Examination

The cornerstone of diagnosis is a careful history that explores when the pain started, how it has progressed, what makes it better or worse, and whether there are any associated symptoms. The provider will ask about activity levels, sports participation, backpack use, screen time habits, and any recent changes in these factors. Family history of spinal conditions, inflammatory diseases, or other relevant conditions may also be explored.

The physical examination includes observation of the child's posture and gait, assessment of spinal alignment and range of motion, palpation for areas of tenderness or muscle spasm, and evaluation of strength, sensation, and reflexes in the legs. Specific tests may be performed to assess for conditions like scoliosis (forward bend test), tight hamstrings, sacroiliac joint dysfunction, or nerve root irritation.

Imaging Studies

X-rays are the first-line imaging study when imaging is indicated. They can identify fractures, spondylolysis, scoliosis, Scheuermann's disease, and other bony abnormalities. However, X-rays are not routinely needed for straightforward cases of back pain that are improving with conservative treatment. They are typically reserved for pain lasting more than 2-3 weeks, pain with concerning features, or when specific conditions are suspected based on the examination.

MRI provides detailed images of the spinal cord, discs, ligaments, and other soft tissues. It is indicated when there are neurological symptoms suggesting possible disc herniation or spinal cord compression, when infection or tumor is suspected, or when pain persists despite treatment and X-rays are normal. MRI in children may sometimes require sedation, particularly in younger children who cannot remain still for the examination.

How Is Back Pain in Children Treated?

Treatment focuses on activity modification rather than complete rest, avoiding movements that trigger pain while maintaining general physical activity. Physical therapy to strengthen core and back muscles is often helpful. Over-the-counter pain relievers can provide temporary relief. Most children recover fully with conservative treatment; surgery is rarely needed.

The treatment of back pain in children emphasizes conservative, non-invasive approaches that address the underlying causes while allowing the natural healing process to occur. Unlike the historical approach of strict bed rest, modern treatment encourages continued activity within pain tolerance, as prolonged inactivity can actually worsen outcomes by weakening the supportive muscles and promoting deconditioning. The specific treatment plan depends on the identified or suspected cause of the pain.

Parents play a crucial role in treatment by helping implement recommended changes at home, encouraging appropriate activity, and monitoring for improvement or concerning developments. Most children with back pain will recover fully within a few weeks with simple measures, though some may require more structured physical therapy or, rarely, other interventions.

Activity Modification and Rest

The key principle is to avoid activities that significantly worsen the pain while maintaining general physical activity and normal daily functions. Complete bed rest is rarely recommended and can be counterproductive. Children should be encouraged to continue attending school, walking, and performing light activities. Specific activities that trigger or significantly worsen pain, such as certain sports movements or heavy lifting, should be temporarily avoided or modified.

For children involved in competitive sports, training intensity may need to be reduced until symptoms improve. This doesn't necessarily mean stopping all sports participation but rather finding a level of activity that doesn't aggravate the problem. Complete avoidance of physical education at school is generally discouraged unless symptoms are severe, as some activity is beneficial for recovery. Working with coaches, trainers, and school staff to develop a modified participation plan can help maintain the child's involvement while allowing healing.

Physical Therapy and Exercise

Physical therapy is one of the most effective treatments for pediatric back pain. A physical therapist can develop an individualized program to strengthen the core muscles that support the spine, improve flexibility in tight muscles (particularly hamstrings and hip flexors), correct postural imbalances, and teach body mechanics for activities that may have contributed to the problem. For adolescent athletes, sport-specific rehabilitation helps ensure a safe return to full activity.

Home exercise programs are typically prescribed, and consistent adherence is important for success. Exercises may include core strengthening (planks, bridges, abdominal exercises), stretching (hamstrings, hip flexors, back muscles), and postural exercises. Swimming is often recommended as it provides excellent exercise while placing minimal stress on the spine. The therapist may also use manual therapy techniques, education about body mechanics, and strategies for preventing recurrence.

Pain Management

Over-the-counter pain relievers such as acetaminophen (paracetamol) or ibuprofen can provide temporary relief for mild to moderate back pain. These should be used at appropriate doses for the child's age and weight and are generally safe for short-term use. However, medications treat symptoms rather than the underlying cause and should not replace appropriate activity modification and physical therapy. If pain relief medications are needed for more than a few days, medical consultation is appropriate.

Ice application can help reduce pain and any inflammation, particularly after activity or when pain flares. Apply ice wrapped in a cloth for 15-20 minutes at a time. Heat may also provide comfort for muscle tension and stiffness. Some children find alternating ice and heat helpful. Topical pain-relieving creams are generally not recommended for children and should only be used under medical guidance.

Posture and Ergonomic Modifications

Addressing factors that may contribute to back pain is an important part of treatment and prevention. For children who sit for extended periods for school or screen time, ensuring proper ergonomics is essential. The chair should support the lower back, feet should rest flat on the floor or a footrest, and screens should be at eye level. Regular breaks every 30-45 minutes to stand, stretch, and move around are important.

Backpack weight and wearing style can significantly impact back pain. Backpacks should weigh no more than 10-15% of the child's body weight and should be worn with both straps over both shoulders, not slung over one shoulder. The heaviest items should be placed closest to the back, and waist and chest straps should be used when available. Rolling backpacks may be appropriate for children with persistent problems, though they have their own limitations.

How Can Back Pain in Children Be Prevented?

Prevention strategies include maintaining a healthy weight, regular physical activity with proper conditioning, appropriate backpack use (less than 10-15% of body weight), good posture habits, and ergonomic workstations. For young athletes, proper training progression and adequate rest are essential.

While not all back pain in children can be prevented, many cases can be avoided or minimized through attention to modifiable risk factors. Prevention strategies focus on building and maintaining a strong, flexible musculoskeletal system while avoiding excessive or improper stresses on the developing spine. These habits, established in childhood, can have benefits that extend into adulthood.

Parents, schools, and coaches all play roles in preventing back pain in children. By promoting healthy activity levels, proper body mechanics, and appropriate training practices, the incidence of pediatric back pain can be reduced. When pain does occur, early recognition and appropriate management can prevent minor issues from becoming chronic problems.

Promoting Physical Fitness and Core Strength

Regular physical activity is one of the best ways to prevent back pain. Strong core muscles (abdominals, back muscles, and muscles around the hips) provide essential support for the spine and help prevent strain and injury. Activities that build core strength include swimming, gymnastics, martial arts, yoga, and various sports. Even regular walking and playing actively contribute to overall fitness and spinal health.

Flexibility is equally important, particularly as children enter puberty and growth-related tightness becomes common. Regular stretching of the hamstrings, hip flexors, quadriceps, and back muscles helps maintain normal flexibility and reduces the risk of muscle strains. Stretching should be incorporated into warm-ups before activity and cool-downs afterward, as well as independently several times per week.

Healthy Habits for Spine Protection

Maintaining a healthy body weight reduces stress on the spine and associated structures. Obesity in childhood is associated with increased rates of back pain, likely due to the additional load on the spine and reduced overall fitness. A balanced diet and regular physical activity help maintain appropriate weight while providing the nutrients needed for healthy bone and muscle development.

Teaching children proper lifting techniques and body mechanics can prevent injury. When lifting, they should bend at the knees rather than the waist, keep objects close to the body, and avoid twisting while lifting. For heavy items, they should ask for help. These habits, learned early, can provide lifelong protection against back problems.

• Limit screen time: Encourage regular breaks and varied activities to prevent prolonged sitting
• Ensure adequate sleep: Quality sleep on a supportive mattress aids growth and recovery
• Stay hydrated: Proper hydration supports muscle function and spinal disc health
• Encourage varied activities: Avoid early sport specialization; varied activities develop balanced fitness
• Model good posture: Children learn by example; demonstrate good posture yourself

Guidelines for Young Athletes

For children involved in competitive sports, proper training practices are essential for preventing back pain. Training programs should include adequate progression, allowing the body to adapt to increasing demands gradually. Sudden increases in training volume or intensity are a common cause of overuse injuries, including back pain. The "10% rule," which limits weekly increases in training volume to 10%, provides a useful guideline.

Adequate rest and recovery are crucial. Young athletes should have at least one or two rest days per week and should avoid playing the same sport year-round without breaks. Early sport specialization, where children focus intensively on one sport from a young age, is associated with increased injury rates including back problems. Participating in multiple sports throughout childhood develops more balanced physical conditioning and reduces overuse patterns.

What Is the Long-Term Outlook for Children with Back Pain?

The prognosis for most children with back pain is excellent. Over 90% of cases resolve completely with conservative treatment. Most children return to full activity without long-term problems. However, children who have back pain are at somewhat higher risk of experiencing it again in the future, making prevention strategies important.

Parents are often concerned about whether childhood back pain will lead to chronic problems in adulthood. The reassuring news is that the vast majority of children with back pain have excellent outcomes. With appropriate treatment and prevention strategies, most return to their normal activities without limitations and experience complete resolution of their symptoms.

Research shows that over 90% of children with back pain recover fully with conservative treatment alone. Even among children with identified causes like spondylolysis or Scheuermann's disease, outcomes are generally good with appropriate management. The developing spine has remarkable healing and adaptive capacity, and most conditions that cause back pain in childhood are successfully managed without surgery or long-term disability.

Factors Affecting Outcomes

Several factors influence the prognosis for a child with back pain. Early recognition and appropriate treatment improve outcomes; prolonged delays in addressing modifiable factors can lead to more persistent symptoms. Children who continue to participate in activities that significantly aggravate their pain may develop more chronic patterns. Conversely, those who adopt healthy habits for spine care often see lasting benefits.

Psychological factors also play a role, as they do in adult back pain. Children who develop fear of movement or activity avoidance may have longer recovery times and are more likely to experience recurrent problems. Maintaining a positive, active approach to recovery, with appropriate activity rather than excessive rest, supports both physical and psychological well-being.

Recurrence and Adult Outcomes

While most episodes of childhood back pain resolve completely, children who have had back pain are at somewhat increased risk of experiencing it again. Studies following children into adulthood show that those with adolescent back pain are more likely to have back pain as adults, though most still function normally. This underscores the importance of prevention strategies and addressing contributing factors like posture, fitness, and body mechanics.

For the small percentage of children with specific diagnoses like scoliosis, spondylolysis, or Scheuermann's disease, long-term monitoring may be recommended. Most of these children also have good outcomes with appropriate management, though some may need ongoing attention to prevent progression or recurrence. Severe cases requiring surgery are uncommon, and when surgery is needed, outcomes are generally favorable.