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Virtual Pediatric Hospital: Back Pain in Children: Summary Back Pain in Children

Summary

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Back pain in prepubertal children often has a serious underlying cause, particularly if any of the seven clinical warning signs of serious causes are present. Back pain in pubertal children often has a non-serious underlying cause, such as musculoligamentous injury from sports. However, musculoligamentous injury remains a diagnosis of exclusion and all adolescents with back pain do need proper work up if any of the seven clinical warning signs of serious causes of back pain are present. Laboratory values are often of little use in the evaluation of back pain in a child, except in cases where there is an elevated white count or sedimentation rate to suggest infection. In cases when clinical warning signs of serious causes are present, imaging is indicated in order to assist in making the diagnosis. Imaging should start with AP and lateral plain films of the spine. If these are negative, imaging should continue with a bone scan. If a lesion is found on plain film or bone scan, it should be further investigated with thin section CT. If plain film and bone scan are negative, MRI may be of use.

All imaging of back pain in children should be done by a radiologist after consultation with the radiologist. In cases were there is a suspected serious underlying cause of back pain, early involvement of an orthopedist is also recommended.

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