Clinical features of selected causes of back pain in children and adolescents without warning signs of serious underlying conditions^[1-3]

Condition	Typical age group/risk groups	Clinical features
Nonspecific musculoskeletal pain and muscle strain
Nonspecific musculoskeletal pain (common)	Older age Sports participation Soft mattress Large breasts (in females) Depression, anxiety, or psychosocial distress Comorbid medical disorders	Absence of warning signs
Muscle strain (common)	All ages	Acute pain Pain during and after activity Pain with twisting or lifting Muscle tenderness without radiation
Thoracic spine pain
Scheuermann (juvenile) kyphosis (common)	Early adolescence More common in males than females Tall males	Subacute/chronic or intermittent/recurrent pain Pain worse with activity and improves with rest Thoracic tenderness Increased pain with flexion Rigid thoracic kyphosis Hamstring tightening
Thoracic or lumbar spine pain
Adolescent idiopathic scoliosis (without activity-limiting pain) (common)	Adolescents (≥10 years of age)	Lateral spinal curvature
Intervertebral disc calcification (rare)	Preadolescents Alkaptonuria May be associated with trauma	Persistent back pain
Lumbar or lumbosacral spine pain
Hyperlordotic low back pain (common) (Also called mechanical back pain)	Weak core muscles	Gradual onset Increased lumbar lordosis
Lumbosacral transitional vertebra (Bertolotti syndrome)	All ages	Gradual onset Poorly localized low back pain
Referred pain
UPJ obstruction (uncommon)	More common in males than females	Intermittent flank pain Pain worse with diuresis Abnormal urinalysis (hematuria)
Cholecystitis (uncommon)	May be associated with hemoglobinopathies	RUQ or epigastric pain that radiates to right shoulder or back Pain precipitated by ingestion of fatty food
Widespread pain (not limited to back)
Pain amplification/chronic pain syndromes (eg, fibromyalgia)	Adolescents	Chronic pain Discordance between reported symptoms and physical findings Frequent school absences

This table is intended for use with UpToDate content related to back pain in children and adolescents. Refer to UpToDate content for additional information about the conditions and laboratory and/or imaging evaluation.

UPJ: ureteropelvic junction; RUQ: right upper quadrant.

References:

Bernstein RM, Cozen H. Evaluation of back pain in children and adolescents. Am Fam Physician 2007; 76:1669.
Haidar R, Saad S, Khoury NJ, Musharrafieh U. Practical approach to the child presenting with back pain. Eur J Pediatr 2011; 170:149.
MacDonald J, Stuart E, Rodenberg R. Musculoskeletal low back pain in school-aged children: A review. JAMA Pediatr 2017; 171:280.

Graphic 122003 Version 4.0

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Clinical features of selected causes of back pain in children and adolescents without warning signs of serious underlying conditions[1-3]

Clinical features of selected causes of back pain in children and adolescents without warning signs of serious underlying conditions^[1-3]