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Back pain in children
1Southmead Hospital, Westbury on Trym, Bristol.
Insights
Pediatric back pain often has serious causes, with mild symptoms masking severe conditions. Recognizing warning signs is crucial for timely diagnosis and treatment in children.
Area of Science:
- Pediatric Orthopedics
- Childhood Musculoskeletal Disorders
Background:
- Pediatric back pain frequently indicates serious underlying conditions, unlike in adults.
- The presentation of serious spinal pathology in children can be deceptively mild.
Purpose of the Study:
- To highlight the distinct causes and presentations of back pain in children compared to adults.
- To identify key warning features necessitating further investigation in pediatric patients.
Main Methods:
- Clinical assessment focusing on specific warning signs.
- Diagnostic imaging, including plain radiographs and scintigraphy, when indicated.
- Review of common and uncommon etiologies of pediatric back pain.
Main Results:
- Half of pediatric back pain cases have specific or serious causes.
- Warning features include early onset (<4 years), prolonged symptoms (>4 weeks), functional impairment, systemic signs, worsening pain, neurological deficits, and new scoliosis.
- Scintigraphy proves valuable when initial assessments are inconclusive.
Conclusions:
- Childhood back pain requires vigilant evaluation due to potentially serious underlying pathology.
- Specific clinical indicators should prompt advanced diagnostic workup to ensure accurate diagnosis and management.
Abstract:
Pay attention to back pain reported by children. Half will have a specific or serious cause, the presenting symptoms of serious conditions may be misleadingly mild, and the spectrum of causes and mode of presentation differ from adults. Warning features include onset aged < 4 yr, symptoms persisting beyond 4 weeks, interference with function, systemic features, worsening pain, neurological features and recent onset of scoliosis. Scintigraphy is often useful where clinical features and plain radiographs fail to identify the diagnosis. Sports activities may cause stress reactions in the immature spine, particularly at the junction between spinal segments of differing mobility, the vascularity of the disc and vertebra predisposes to infection, spinal tumours presenting as pain tend to be primary and benign, congenital spinal anomalies causing pain tend to present in childhood, spondylitis presents differently from adults, and conversion hysteria, typically presenting with gross, bizarre and disabling symptoms, is not uncommon in adolescent girls.