Back Pain in Children
William P. Bunnell MD1
1 Director of Orthopaedics, Assistant Medical Director, Alfred I. duPont Institute, PO Box 269, Wilmington, DE 19899
Back pain in a young child or adolescent is an unusual complaint and must be regarded as a possible indication of the presence of significant pathology. Functional and mechanical causes of back pain in this age group are uncommon; therefore, it is most important that a vigorous attempt be made to establish the primary diagnosis. The purpose of this paper is to review the distinctive features of the history and physical examination that may lead to accurate diagnosis, and to outline a logical approach to the laboratory and radiographic evaluation for each of the major causes of back pain.
HISTORY
A carefully obtained medical history is frequently the most helpful factor in establishing a diagnosis. In addition to providing important information, it also establishes an attitude of mutual trust and understanding between the physician and patient. A skillfully taken history can help the physician gain vital insight into the patient's attitude toward his or her disease and suggest areas to be emphasized for further evaluation. Specific aspects of the history that are most revealing include: the mode of onset, nature and severity of the pain; a change in symptoms; and associated systemic complaints (Table 1).
The mode of onset should be determined as specifically as possible.
