Putting It All Together: What to Keep and What to Refer?

Back pain is very common in children and even more common in adults. Back pain is a symptom, not a diagnosis, so seek a deeper understanding of the condition. Always evaluate the child’s development and growth. Be very concerned about a young child with a stiff spine, night pain, or abnormal neurological findings. Seek the underlying diagnosis in evaluating back pain or scoliosis. For the child under age 10 years, consider inflammation and the common pitfalls to avoid—especially tumors and infections. Stiffness can be a sign of inflammation. This inflammation can show up as night pain, limp, or refusal to walk. For the child older than age 10 years, think of mechanical origins, spondylolysis, spondylolisthesis, or Scheuermann kyphosis, but don’t forget the possible pitfalls. After a thorough evaluation, there may be no specific diagnosis, and you then need to reassure the family and provide comfort.