Spinecare Topics
Back Pain in Children
In some children chronic back pain may be the first sign of arthritis. When arthritis involves the spine and extremities it may be referred to as a spondyloarthropathy. These children frequently describe being stiff when they first wake up in the morning. They may even “walk like an older person�. One of the most common forms of systemic arthritis is rheumatoid arthritis. There is a juvenile form of the disease.
Low back pain can develop secondary to a problem in the back or it can arise secondary to a problem involving one or more organ systems. In the later pain may be referred to the back region. The presence of one or more of the following signs and/or symptoms in a child or adolescent warrants evaluation by a healthcare provider. Specialized diagnostic testing may be required.
- low back pain accompanied by pain in extremity joints (polyarthralgia);
- extremity numbness or tingling
- persistent low back pain followed by blunt force trauma
- low back pain and progressive malaise/fatique;
- pain which awakens the child from sleep;
- no improvement with the use of over the counter analgesics such as acetaminophen [Tylenol], or ibuprofen [Advil];
- progressive pain;
- fever;
- change in cognitive status;
- low back pain accompanied by abdominal or pelvic complaints;
- appetite changes;
- loss of bowel and/or bladder control;
- difficulty with gait;
- muscle incoordination or weakness.
Like in adults back pain in children and adolescents can range from mild to incapacitating. The causes of back pain in children and adolescents can be classified into one of four primary categories which are 1) mechanical back pain, 2) developmental abnormalities, 3) inflammatory and infectious diseases and 3) neoplastic disorders (cancer). One of the most common developmental/structural causes of low back pain in younger individuals is spondylolysis and spondylolisthesis. Spondylolysis refers to a defect in the posterior part of the vertebrae whereas spondylolisthesis refers to slippage of a vertebra. Gynecological pain in adolescent girls such as dysmenorrheal with referral to the back can easily be overlooked. This possibility should be considered by primary care physicians and gynecologist. The following table acknowledges the most common causes of back pain in children and adolescents.
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