Back pain in the pediatric population remains an unusual and concerning complaint that may be an indicator of serious underlying pathology. This issue reviews rare but dangerous etiologies of pediatric back pain and highlights signs and symptoms that may raise a red flag for potentially dangerous etiologies of back pain among children and teens. The evaluation of these patients, including judicious and effective imaging recommendations, is also discussed. A data-driven algorithm for evaluating patients can save the majority of patients from the expense and anxiety of unnecessary testing while effectively identifying the most appropriate means (and locations) for working up pathologic pediatric back pain.
How would you manage these patients? Subscribe for evidence-based best practices and to discover the outcomes.
Subscribe to access the complete flowchart to guide your clinical decision making.
Subscribe for full access to all Tables.
Buy this issue and
Following are the most informative references cited in this paper, as determined by the authors.
17. * Brooks TM, Friedman LM, Silvis RM, et al. Back pain in a pediatric emergency department: etiology and evaluation. Pediatr Emerg Care. 2018;34(1):e1-e6. (Retrospective review; 177 patients) DOI: 10.1097/PEC.0000000000000798
18. * Bhatia NN, Chow G, Timon SJ, et al. Diagnostic modalities for the evaluation of pediatric back pain: a prospective study. J Pediatr Orthop. 2008;28(2):230-233. (Prospective intervention; 73 patients) DOI: 10.1097/BPO.0b013e3181651bc8
19. * Biagiarelli FS, Piga S, Reale A, et al. Management of children presenting with low back pain to emergency department. Am J Emerg Med. 2019;37(4):672-679. (Retrospective cohort; 148 patients) DOI: 10.1016/j.ajem.2018.07.012
20. * Feldman DS, Straight JJ, Badra MI, et al. Evaluation of an algorithmic approach to pediatric back pain. J Pediatr Orthop. 2006;26(3):353-357. (Prospective intervention; 87 patients) DOI: 10.1097/01.bpo.0000214928.25809.f9
25. * Ramirez N, Flynn JM, Hill BW, et al. Evaluation of a systematic approach to pediatric back pain: the utility of magnetic resonance imaging. J Pediatr Orthop. 2015;35(1):28-32. (Prospective interventional; 261 patients) DOI: 10.1097/BPO.0000000000000190
27. * Nitta A, Sakai T, Goda Y, et al. Prevalence of symptomatic lumbar spondylolysis in pediatric patients. Orthopedics. 2016;39(3):e434-e437. (Prospective observational; 136 patients) DOI: 10.3928/01477447-20160404-07
39. * Afshari FT, Rodrigues D, Bhat M, et al. Paediatric spondylodiscitis: a 10-year single institution experience in management and clinical outcomes. Childs Nerv Syst. 2020;36(5):1049-1054. (Retrospective review; 21 patients) DOI: 10.1007/s00381-019-04470-z
56. * Burgos-Vargas R. The juvenile-onset spondyloarthritides. Rheum Dis Clin North Am. 2002;28(3):531-560 (Review) DOI: 10.1016/s0889-857x(02)00033-9
67. * Expert Panel on Pediatric Imaging, Booth TN, Iyer RS, et al. ACR Appropriateness Criteria® Back Pain-Child. J Am Coll Radiol. 2017;14(5S):S13-S24. (Consensus statement) DOI: 10.1016/j.jacr.2017.01.039
68. Radiologyinfo.org. Radiation dose to adults from common imaging examinations. 2022; Accessed March 1, 2023. (Educational media)
73. Wu W, Miller E, Hurteau-Miller J, et al. Development and validation of a fast spine protocol for use in paediatric patients. Research Square (Preprint). 23 Aug 2022. (Retrospective review; 105 patients)
91. Villalpando N, Austin American-Statesman. Kids learning about back pain from doing school virtually. 2021; Accessed March 1, 2023. (News article)
92. Stenson J, NBC News. Remote learning can be a pain for kids in more ways than one. 2020; Accessed March 1, 2023. (News article)
93. Duarte-Ladd D, amNY. Here are some expert tips on COVID back soreness and pain in kids. 2020; Accessed March 1, 2023. (News article)
Subscribe to get the full list of 98 references and see how the authors distilled all of the evidence into a concise, clinically relevant, practical resource.
William C. Sokoloff, MD, MSEd; Matthew P. Kusulas, MD, MSEd
Mary Jane Piroutek, MD; Winnie T. Whitaker, MD
April 1, 2023
April 1, 2026   CME Information
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.