6 Causes of Back Pain in Children

Back pain is usually considered a problem during middle and older age, but a 2020 study found that more than a third of children and adolescents reported experiencing back pan in the previous year, and almost 9% reported severe back pain in the previous year.

Some reasons that kids and teens get back pain include obesity, intense year-round sports activities, and wearing a heavy backpack at school.

This article will go over the possible causes of back pain in children. You’ll also learn the warning signs that would mean it’s time to call your child’s provider.

when to worry about back pain in kids
Verywell / Cindy Chung

Does My Child Need to See a Provider for Back Pain?

There are many reasons a child can have back pain. While it can be something minor like a pulled muscle, back pain can also have a more serious cause.

Back pain is more likely to point to a serious problem in kids than it is in adults. This is especially true if a child’s back pain does not get better in a few days or starts to get worse.

Call your child’s provider if your child:

  • Has back pain and is age 4 or younger
  • Has pain at night (especially if it wakes them up)
  • Has constant pain or pain that lasts for more than several weeks
  • Has pain that shoots down one or both legs

When to Go to the ER

Seek emergency care if your child has back pain along with these symptoms:

1

Muscular Pain

Muscular back pain is the most common reason for back pain in children and adolescents. They might say their back aches or feels sore and tender.

This kind of back pain is often from muscle strains and ligament strains, as well as overuse. Kids that play intense, year-round sports are particularly at risk for these injuries.

Problems with posture can also lead to back pain in people of any age and can be a source of long-term discomfort.

Children who are overweight or have obesity can also have pain from the stress that extra weight puts on their back muscles, ligaments, and bones.

Diagnosing Muscular Pain

Tests like X-rays, magnetic resonance imaging (MRI), and other imaging tests are not helpful for diagnosing muscular back pain. If your child does not have other symptoms, your provider probably won’t order these tests.

There are downsides to doing more testing than is needed, including exposing a child to a lot of medical radiation. Don’t hesitate to ask your child’s provider why they are ordering a test and if it’s really necessary.

Treating Muscular Pain

Muscular back pain will usually get better if your child rests. Using heat and ice treatments can also help soothe the ache.

In the short term, your child might benefit from physical therapy, stretching programs, yoga, or massage treatment. However, these treatments may not help with long-term back pain.

2

Stress Fractures

Stress fractures in the spine are common causes of back pain in adolescents.

However, your teen might not even realize they are injured, as symptoms can take time to show up.

If they do start to feel pain from the fracture, it will probably feel like a dull ache in the place where the break has occurred. They might also notice that the pain gets worse when they’re moving and feels better when they’re resting.

Types of Stress Fractures

The most common type of spinal stress fracture is called spondylolysis. It’s a bone injury that happens in the back of the spinal column.

The injury is common in adolescents who do sports that involve repeatedly bending backward (hyperextension), such as gymnastics and diving.

If the stress fracture occurs on both sides of the spinal column, it can become unstable. This condition is called spondylolisthesis or a “spinal slip,” and it can cause alignment problems within the backbones (vertebrae).

Teens with this type of fracture may also notice stiffness in their back and legs, which might affect their ability to walk. If the slip is very bad, a teen might start having numbness and tingling in their back or legs.

Will My Child Need Surgery?

Most kids and teens with spondylolysis do not need surgery. Many young patients actually do better with nonsurgical treatments like physical therapy, chiropractic care, and wearing a brace.

Surgery is typically reserved for children with pain that doesn’t go away even after many months of trying other options.

Children with severe slips that lead to loss of spinal alignment may need surgery as well.

Even with treatment, the symptoms of a stress fracture may last into adolescence and young adulthood.

3

Disc Problems

A disc herniation of the spine means that the soft cushion between two vertebrae is ruptured. The disc material is squeezed out and can push against the nerves and spinal cord.

In children, the disc material is very elastic, which helps the spine handle unusual forces. As we get older, the discs lose their elasticity and are more likely to rupture.

However, discs can rupture in a child’s back if they experience excessive forces (like a traumatic injury). Ruptures can also happen if the discs have an abnormal structure.

Symptoms of a disc herniation include:

Disc herniations are much less common in children than in adults. However, when they do happen, they can cause serious problems.

Diagnosing and Treating Disc Problems

MRI tests can be helpful to diagnose disc herniation. X-rays, on the other hand, will typically be normal.

Disc herniations can usually be managed without surgery. However, children and adolescents with severe pain or signs of nerve injury may benefit from surgery to relieve pressure on the nerve.

4

Infections

Toddlers, children, and adolescents can get infections that involve their spines. The symptoms of these infections vary but can include back pain, low-grade fevers, and a general feeling of being sick (malaise).

Spinal Meningitis

One of the most serious infections of the spine is meningitis. It can be caused by bacteria, viruses, fungi, and other germs. Meningitis that is caused by bacteria is a medical emergency.

If your child has back pain and any of these symptoms of meningitis, go to the emergency room right away:

  • High fever
  • Stiff neck
  • Severe headache
  • Sensitivity to light
  • Seizures
  • Vomiting
  • Confusion, behavior changes

Diagnosing and Treating Infections

Infections of the spinal bones or discs can be hard to diagnose, but there are some key things a provider will look for.

Abnormal blood tests showing signs of infection or markers of inflammation will be clues about the cause of your child’s back pain. Imaging tests can be used to help providers figure out where the infection is.

If the infection is caused by bacteria, your child will need to have antibiotics. They may need to get them through an IV instead of by mouth.

Surgery is only considered if the infection has damaged the spinal cord, is not getting better with antibiotics, or other complications develop.

5

Alignment Problems

If your child’s spinal alignment is abnormal, it can cause back pain. It may change how your child’s back looks as well. Sometimes, the deformities are easy to see but don’t cause pain.

The two most common spinal deformities in children are:

  • Scoliosis is a deformity that causes an S-shaped curve in the spine. You can see the deformity when you look at your child’s back.
  • Scheuermann’s kyphosis is a condition that causes a sharp bend in the spine. You can see the shape when you look at your child from the side.

A provider can measure the curve of your child’s spine by taking X-ray or MRI images.

Will My Child Need Surgery?

While these two conditions are very different, the treatments are similar. If the deformity is severe, a child may need to wear a back brace.

Surgery is only considered for severe deformities. However, deformity of the spine may remain after surgery, as a full spinal correction can cause more problems than a partial one.

6

Tumors

Several noncancerous (benign) and cancerous (malignant) bone tumors can occur in the spinal column.

While spinal tumors are a very uncommon cause of back pain in children and teens, a provider may still consider them a possibility.

Some tumors cause a lot of pain, while others may not cause any symptoms.

Some of the “red flag” signs that can happen with back pain caused by a tumor are pain at night, generalized illness, or weight loss.

If a child has these symptoms, their provider may want to order tests to look for a tumor.

Treating Spinal Tumors

The treatment for spinal tumors depends on the type of tumor. Even tumors that are not cancer may require surgery because they can lead to spine deformities.

Cancerous tumors in the spine often need a combination of treatments, including medications, radiation, and surgery.

Summary

While it’s not as common as it is in adults, back pain can be a problem for kids and teens. Children who play sports, lug heavy backpacks at school, or are at a higher body weight are more likely to have back pain.

Muscular injuries, stress fractures, and disc herniations are common reasons that young people have back pain.

Less commonly, serious conditions like spinal infections and tumors can cause back pain in kids. In these cases, there are usually “red flag” symptoms in addition to back pain.

A Word From Verywell

If your child has back pain, it’s natural to be concerned. As their caregiver, you don’t want to see them be uncomfortable or have to miss out on their favorite activities.

That said, most causes of back pain in kids and teens will get better if they take it easy and rest.

However, if your child’s back pain isn’t getting better, is getting worse, or they have other symptoms that are troubling, it’s time to call their provider.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.