The backache was initially thought to be uncommon in children, unlike adults. However, the incidence of backache in children is rising probably due to changing lifestyles. Before we dwell into the details of backache, letтАЩs begin with the understanding of back in the children.
Our back which we call spine also is made up of numerous vertebrae. These vertebrae are connected to each other with discs. The role of disc is to act as a shock absorber during movement of the spine. The spine is divided into 5 parts based on location. They are cervical, thoracic, lumbar, sacral, coccygeal. Now, a newly born infant has a single C shaped lordotic curve (Concave anteriorly and convex posteriorly) of the spine due to the foetal position in the womb. However, as the infant grows and develops neck holding and subsequently sitting and walking, the curve of spine changes. The cervical and lumbar regions become lordotic (Convex anteriorly and concave posteriorly) also known as secondary curves while the thoracic and sacral regions retains their kyphotic curves ( primary curves). The understanding of these developments in the spine during growth is essential as the most common cause of backache in children is faulty postures.
Red Flags associated with backache:
1. Recent significant trauma
2. Persistent Fever
3. Significant weight loss ( > 10% of body weight during 3 months)
4. Any recent change in walking pattern as noticed by parents or closed ones
5. Pain radiating to one or both legs
6. Weakness or sensation loss in either leg
7. Loss of control of bladder or bowel
If the parents notice any of the red flag signs mentioned above, they need to see an orthopaedic surgeon who will completely examine the child. The child might need some blood and radiological examination depending on the examination findings.
LetтАЩs discuss some of the treatment options if your child has significant backache. First of all, the majority of backache are related to faulty postures same as in adults. Hence, the need for posture modification. It has been found that one of the common causes of backache is carrying heavy school bags. The simple rule that can be followed is that the schoolbags should not weigh more than 10 % of child body weight. The children should be taught core muscle strengthening exercises, hamstring stretches and abdominal strengthening exercises. There are certain conditions like Infection, scoliosis, Scheuermann kyphosis, spondylolisthesis, Disc prolapse, tumors that warrant immediate attention of orthopaedic surgeon.
Take home message
1. Most of the backaches in children are benign and can be treated by posture modification and exercises.
2. If there are red flag signs associated with backache, immediate attention of orthopod is required.
3. Try to motivate the child to engage in as many physical activities as possible.
Dr. Mohit Kumar Arora, Associate Consultant тАУ Pediatric Orthopaedics, Narayana Superspeciality Hospital Gurugram