Severe back pain in children and adolescents

If in adults most diseases and disorders in the body, in particular all kinds of severe back pain, are associated mainly with hypodynamia, then for children who are active from birth this reason is irrelevant, especially before the child goes to school. It is not surprising that children under 6 years old very rarely have spinal pain, unless their appearance is associated with a spinal injury, as well as with hereditary or acquired pathologies:

• skeletal developmental anomalies, as a result of which the load on the spine is not distributed correctly or a nerve is pinched in the area of the congenital defect,
• tumors in the spinal cord and bone-cartilaginous structures, as well as metastases of cancer affecting internal organs,
• anomalies in the development of internal organs, which may cause reflected pain in the back,
• infections of bones and cartilage (eg, osteomyelitis or tuberculosis of bones),
• inflammatory diseases of the kidneys and bladder with pain radiating to the lumbosacral region of the back,
• sickle cell anemia is a hereditary blood disorder in which back pain occurs due to blockage of small blood vessels that supply the spinal cord, decreased bone density, and joint damage,
• hereditary spherocytic anemia, which is characterized by: liver damage and enlargement of the spleen, accompanied by pressure on the nerve roots and the appearance of reflected pain in the back, as well as pathological enlargement of individual parts of the body.

Fortunately, these and some other pathologies, one of the symptoms of which can be moderate and severe back pain, are rarely diagnosed in preschool age. And for the appearance of acute symptoms of the disease, some predisposing factors are needed: hypothermia, physical exertion, strong emotional experiences, injuries.

Younger school-age children may complain of back pain associated with the need to sit at a desk for a long time. The spine of children is not used to such a large static load and can react with rapid fatigue and pain. But their intensity is very difficult to assess, because the reluctance to sit at a desk for a long time encourages little fidgets to exaggerate the strength of unpleasant sensations.

The most common cause of moderate to severe back pain in school-age children is scoliosis, which in most cases is caused by a child's poor posture, which is most noticeable during the period of active skeletal growth. No matter how much teachers and parents monitor how a child sits at a desk, when they get tired, children sometimes take the most uncomfortable positions and over time their spine takes the form of an arc or a winding line. And the incorrect position of the spine increases the load on the muscles and can provoke pinching of the nerve roots.

True, the disease can occur much earlier. It's just that its first symptoms become noticeable after several years. In this case, the parents themselves become the cause of the baby's back problems. Risk factors for the development of scoliosis at an early age, when the spine is not yet strong enough, are considered to be:

• carrying a baby on one arm,
• attempts by parents to force a baby to sit or walk ahead of time,
• driving by the same handle, etc.,
• a bed that is too soft, distorting the shape of the spine during sleep,
• limiting the baby's mobility (a preschooler can sit still for no more than 20 minutes, so don't insist that he spend hours drawing or playing board games).

But most often, teenagers suffer from scoliosis, because it is during this period that the most intensive growth of the skeleton is observed, but children of this age are no longer very attentive to the requirements for maintaining correct posture.

Many teenage boys and some girls in their teens are actively involved in sports. But not everyone approaches training with sufficient caution. And as a result, complaints arise about severe back pain caused by muscle strain or injuries, the risk of which increases during sports.

It is not by chance that there is an age limit for lifting heavy objects. A child can easily strain his back while lifting heavy objects both during sports and at home. As a result, there is a sharp cutting pain in the back and lower back.

Increased physical activity of children of different ages conceals another danger. Active movements, especially when playing sports, are associated with intensive blood circulation and warming up of muscles. But it is worth sitting down with a wet back and letting it cool down, as a cold of muscles with their subsequent inflammation (myositis) is guaranteed. Children think little about this, and when there are no parents or mentors nearby who would remind them of the danger of such carelessness, they quite often encounter severe aching pain in the back, which is characteristic of inflammation. Palpation reveals a painful, tense muscle, which is the source of noticeable discomfort.

The other extreme is the passion of children and teenagers for computer games, online communication, searching for forbidden sites and other Internet entertainment. This implies a long stay in a sitting position at the computer, which is fraught with a large load on the spine and spasms of the back muscles.

Children with excess weight are at increased risk of spinal pain even with sufficient physical activity. In this case, the weight of the child's body itself presses on the lower back and legs, which can lead to deformation of the vertebrae and intervertebral discs with the early development of pathologies such as intervertebral disc herniation, spondylolisthesis, etc.

Spinal fatigue during prolonged sitting in class in children and adolescents is associated with low-intensity back pain, while spinal column and coccyx injuries can be very painful. Children with suspicious and unstable psyche may also experience acute pain in the upper back and shoulders, which are psychogenic in nature and appear against the background of stress.

Pain syndrome in infectious and inflammatory pathologies of internal organs is mainly reflected aching pain. The nature of pain in various diseases of the spine depends on the stage of the process (exacerbation or remission) and which structures are damaged by the disease. If the pain occurs after a cold (typical for acute respiratory viral infections and flu), which is not uncommon in childhood, then it has a pressing or aching dull character, because it is provoked by inflammation of the back muscles. Severe piercing pain appears only when local spasmodic areas (trigger points) are formed in the muscles, when pressing on which the symptom intensifies many times.

It is important to understand that it is difficult to describe to a child the strength and nature of spinal pain, so a large role in understanding the problem is given to parents. By carefully observing the behavior of a child or teenager, you can form a more or less clear idea of when the pain appears, what contributes to its intensification, and by palpating the child's back, you can understand in which part of the back the pain syndrome is the strongest. This information, if shared with a pediatrician, will help the latter to correctly select the research methods and make an accurate diagnosis.

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