Back pain in children: a holistic approach to diagnosis and management

Back pain is a relatively common complaint presenting to the primary care practitioner and is addressed with increasing frequency in the pediatric literature. Back pain is not uncommon in adolescents and often is symptomatic of a relatively benign musculoskeletal etiology. Back pain in children less than 10 years of age and most especially less than 4 years of age can signal a more alarming underlying condition. Evaluation requires a complete history including psychosocial and cultural considerations. Additionally a thorough clinical examination, strategic lab work and judicious imaging are imperative. Management and appropriate referral is specific to the underlying disease process. A holistic, individualized plan of care with inherent involvement of the child and parent/caregiver is essential to ensure safety and enhance outcomes.