Evaluation of back pain

Back pain in childhood has been shown to be far more common than previously thought, with the estimated lifetime prevalence as high as 70–80% by the age of 20. For most of these children, the pain is not severe enough to limit their daily activities and they do not present to the clinician. However in those that do it is important to have a clear strategy for the consult to ensure that those likely to have serious underlying pathology are appropriately investigated and are referred to specialists promptly. Likewise it is helpful to be able to identify those with non-specific musculoskeletal back pain who are likely to respond well to conservative management with rest, analgesia and physiotherapy as necessary. This article provides an overview of the important and common causes of back pain in children, and highlights key features in the history and examination that should raise suspicion of an underlying disorder and prompt further investigation.