Back

Back pain in children can arise from a wide range of causes, from benign mechanical problems to serious underlying pathology. Careful assessment is important to identify red flag features and guide appropriate referral.

Scoliosis

Scoliosis is a lateral curvature of the spine. In most children it is painless; however, painful scoliosis is a red flag and may indicate serious underlying disease such as tumour or infection, requiring urgent specialist assessment.

Infection

Spinal infection, including vertebral osteomyelitis or tuberculosis, should always be considered in a child with persistent or unexplained back pain. Presentation may include localised pain, reduced mobility and systemic symptoms such as fever or malaise, although symptoms may be subtle in some cases.

Mechanical back pain

Mechanical back pain is common in older children and adolescents. It is often associated with poor posture, physical inactivity, excess weight, or asymmetrical loading (for example carrying a heavy school bag on one shoulder). Although usually not serious, it can have a significant impact on daily activities and quality of life.

Sport-related back pain

Certain activities, particularly those involving repetitive spinal extension or rotation such as cricket bowling or gymnastics, increase the risk of back injury. These may result in conditions such as spondylolysis or spondylolisthesis, which can present with localised pain, tenderness and activity-related symptoms.

Scheuermann’s disease

Scheuermann’s disease is an osteochondrosis of the thoracic spine leading to vertebral wedging and thoracic kyphosis, often with a characteristic slouched posture. It is frequently identified incidentally on imaging, although some children may report back pain.

Inflammatory back pain

Inflammatory back pain may be a feature of juvenile idiopathic arthritis or arthritis associated with inflammatory bowel disease. It typically presents in older children and adolescents, often with morning stiffness and improvement with activity.