Kids don't get back problems
He was nine years old and had been complaining of back pain for three weeks. His GP had reassured the parents twice. 'Kids don't really get back problems,' they'd been told. By the time they came to me, there was something worth finding — and finding it early made all the difference.
What Patients SayMy 10-year-old has been complaining of back pain. My GP said it's probably nothing — kids don't get back problems. Should I be worried?
Where Did This Come From?
Back pain has traditionally been thought of as an adult problem — the result of decades of loading, wear, and tear. It doesn't fit the mental model of childhood. So when a child reports back pain, the default assumption is that nothing structural is wrong, and the pain is attributed to posture, activity, or attention-seeking.
This assumption is both right and wrong in important ways. Most childhood back pain is benign and self-limiting. But the causes and red flags in children are different from adults, and some are more serious and require earlier attention than the equivalent adult presentation.
What the Science Actually Says
Prevalence studies show that back pain in children and adolescents is actually quite common — lifetime prevalence in teenagers approaches adult rates. Most of it is benign, musculoskeletal, and related to activity, growth, or posture. But the "kids don't get back problems" belief has led to under-investigation of paediatric back pain, which has consequences.
Conditions specific to growing spines include: Scheuermann's disease (structural kyphosis from abnormal vertebral growth), spondylolysis (a stress fracture of the pars interarticularis, common in young athletes), and disc herniations (less common than in adults but they do occur). These have specific treatments and outcomes that differ from adult equivalents.
Critically, back pain in younger children (particularly under 10) has a higher proportion of serious pathology than adult back pain — including spinal infections, tumours, and early inflammatory disease. The "it's probably nothing" dismissal is more dangerous in young children than in adults. Persistent or severe back pain in a child under 10 warrants investigation.
The Verdict
Children do get back problems. Most adolescent back pain is benign, but the causes and red flags differ from adults. Younger children (under 10) with significant or persistent back pain deserve proper investigation.
What To Do Instead
- For brief, activity-related back pain in a child: rest and watchful waiting is appropriate
- For persistent back pain (more than 2–4 weeks) in a child: push for proper assessment including history, examination, and if indicated, imaging
- For a young athlete with back pain: consider spondylolysis — a stress fracture at the pars, requiring specific diagnosis and management
- Don't dismiss back pain in a child under 10 as "nothing" — the threshold for investigation should be lower than in adults
Yellow Flags — Worth Monitoring
- Back pain in a child that wakes them at night — concerning pattern, warrants assessment
- Back pain in a child with stiffness worse in the morning — possible juvenile inflammatory arthritis
- Back pain in an adolescent athlete with pain specifically with hyperextension — consider spondylolysis
Red Flags — Get Checked Immediately
- Back pain in a child accompanied by fever, weight loss, or malaise — possible infection or malignancy, urgent assessment
- Any neurological symptoms in a child with back pain
- Back pain in a child under 5 — serious pathology is disproportionately more common at this age
- Hestbaek L et al., "Low back pain in children — a growing problem," European Spine Journal, 2006. Feldman DS et al., "Evaluation of an algorithmic approach to pediatric back pain," Journal of Pediatric Orthopaedics, 2006.