When your toddler complains of back pain, it's hard to know what to do. It may not be easy to tell how serious it is or what's causing the pain. However, rest assured most causes of back pain in young patients are fairly benign. There are simple steps you can take to treat the pain and determine if the cause is more serious.
What to Do
The first thing to do when your toddler complains of back pain is to decide if she appears ill or is in acute distress and needs to see a doctor immediately. If she does not, give her pain medicines approved by her doctor if she needs it.
What to Watch For
If her pain continues, call your doctor or take her to see him if at any time you note any of the following symptoms:
- She has moderate to severe pain, or constant pain, that is not relieved by pain medicine or is getting worse.
- She has a fever, night sweats, lack of appetite or recent weight loss, which might suggest an infection or tumor.
- She is irritable or lacks energy.
- Her pain increases with movement, she develops difficulty moving her limbs or walking, is reluctant to walk, or walks with a limp.
- She has burning when she urinates or is urinating more frequently.
- She has pain at night which disturbs her sleep, which might suggest a tumor.
Her spine isn't straight, which might be a sign of a birth defect or tumor, or may be due to weak back muscles or posture.
Your child's pain may resolve with or without pain medicine if it is from a benign cause. If she is getting better, you can continue to watch her to see if the improvement continues.
While You Observe
Observe your toddler closely over the next two or three days. She will likely let you know if she is not improving. As long as the pain is resolving and there is no apparent reason for concern, you don't need to restrict her activities while you continue to observe and assess her condition.
When Signs and Symptoms Continue
Take your child to see her doctor if any of the following signs and symptoms are present:
- Her back pain was improving but is now getting worse.
- Her pain was intermittent but is now constant.
- Pain medicines worked initially but no longer relieves her pain.
- Her walking is getting worse.
A doctor's evaluation will include:
- Detailed History - Before you go, make note of the history of your toddler's pain pattern, any associated problems, her past history of illnesses, and your personal and family medical history.
- Physical Exam - Her doctor will do a complete physical exam to look for the cause of the back pain and to determine the next steps.
- Further Testing - This may include blood work to look for evidence of infection, inflammation, or immune diseases as well as imaging studies such as x-rays and MRI scans to look for bone, muscle and soft tissue abnormalities.
In many cases, the cause of the back pain is diagnosed from the history and physical exam alone, and further testing is not necessary. A small percentage of causes are serious and require surgery. However, most of the time the problem can be helped by conservative treatment, such as pain medicine, antibiotics, physical therapy, or physical activity.
Causes of Back Pain in Children
American Family Physician (AFP) writes that serious causes of back pain are uncommon in young children, although they are more common than in older children and adults. AFP and an American Journal of Neuroradiology article review both benign and more serious causes of back pain in children. In addition to weak muscles and poor posture, the main categories include:
- Traumatic injuries to the spine including vertebral fractures
- Musculoskeletal problems such as vertebral disc herniation
- Infection in the vertebrae or discs such as osteomyelitis or diskitis
- Inflammation such as juvenile rheumatoid arthritis
- Tumors, including benign and malignant
Toddler back pain could be also from diseases outside the spine, such as sickle anemia, urinary tract infection, or a systemic viral or bacterial infection.
Movement, Posture and Back Pain
According to Dr. Dieter Breithecker, a German expert in movement and posture, another potential cause for back pain in toddlers is poorly developed back muscles due to the restriction of spontaneous movement.
Prevention of Pain
Based on his research on "health, kinetics, and the complex interactions of the body, mind and soul," he believes that restricting spontaneous body movement from birth deters the development of strong muscles and good posture. He also notes, "Spontaneous movement and good posture affect learning and development in children, and holistic health in all age groups." He concludes, "Prevention of back pain must start in early childhood by encouraging freedom of movement." To start your child on a path of good posture, Dr. Breithecker suggests:
- Have your child spend more time barefooted to promote sensory and motor development.
- Encourage unrestricted, spontaneous whole body movement, allowing her to explore her safe environment and move without too many restrictions.
- Avoid prolonged confinement in a chair, swing, playpen or bed.
Movement and activity will help your toddler continue to develop all her muscles and strengthen her back posture.
Observe but Relax
When your toddler complains of back pain, observe her closely for other symptoms that indicate she might have a significant back problem. However, rest assured that most of the time back pain in a toddler is not caused by a worrisome disease. Ensure that your toddler develops her muscles and good posture by giving her the freedom and opportunities to engage in a variety of spontaneous movement.