Children's Hospital Colorado

Back Pain

Urgent or Emergency Care?

If you believe your child needs immediate attention and you have concerns for a life-threatening emergency, call 911. Not sure what counts as urgent and what's an emergency when your child is sick or injured? When it can't wait, know where to take your kids.

Help Me Decide

  • Pain or discomfort in the upper, mid or lower back
  • Minor muscle strain from overuse and back injury are included

Causes of Back Pain

  • Strained Back Muscles. New backaches in teens are mostly from strained back muscles (muscle overuse). The pain is mostly in the lower back and near the center. There are 200 muscles in the back that allow us to stand upright.
  • Work Triggers. Carrying something too heavy or lifting from an awkward position can cause back pain. Bending too far backward or sideways can cause back pain. Digging in the garden for too long causes overuse of back muscles.
  • Exercise. New exercises or changes in an exercise routine can cause back pain. This is also called muscle overuse.
  • Back Packs. In school-age children, heavy backpacks have become a common cause. They also can cause shoulder and neck pains. Children who have not gone into puberty are at greater risk. Reason: They lack the muscle mass.
  • Kidney Infection (Serious). Pain is on one side in the middle of the back. Other symptoms are fever and pain when passing urine.
  • Kidney Stone (Serious). Pain is on one side of the mid-back and shoots into the lower belly. The pain is extremely severe. The urine has blood in it.
  • Sciatic Nerve Pain (Serious). Sciatica is pain caused by a pinched nerve in the lower back. Sciatica gives a burning pain in one buttock. The pain shoots into the back of the leg on that side. The most intense pain can be in the lower leg and foot. Leg weakness, numbness or tingling can also occur. A ruptured disk causes the pressure on the nerve. Sciatica is rare in children but common in adults.

Symptoms of Back Pain

  • Strained back muscles cause most of these symptoms:
  • The pain is in the middle or lower back
  • The pain is made worse by bending
  • The muscles near the spine are tender to the touch
  • The muscles may be tight (in spasm)

Pain Scale

  • Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
  • Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
  • Severe: The pain is very bad. It keeps your child from doing all normal activities.

Call 911 Now

  • Pain starts after major injury (such as a car crash or football). Caution: Do not move your child until a spine board is put on.
  • You think your child has a life-threatening emergency

Go to ER Now

  • Can't pass urine or can only pass a few drops
  • Can't walk or can barely walk

Call Doctor or Seek Care Now

  • Severe pain
  • Pain shoots into the buttock or back of the thigh
  • Tingling or numbness in the legs or feet
  • Blood in urine
  • Pain or burning with passing urine and fever
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Pain or burning with passing urine, but no fever
  • Fever
  • Walks different than normal for more than 3 days
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Age is less than 5 years
  • Pain in the upper back
  • Cause is not clear (no history of overuse or twisting)
  • Cause is bending backwards (such as in gymnastics)
  • Back pain from overuse (exercise or work) lasts more than 2 weeks
  • Back pains are a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Strained back muscles (from exercise or work) present less than 2 weeks

Care Advice for Strained Back Muscles

  1. What You Should Know About Back Pain:
    • Most new lower back pain is caused by lifting heavy objects. Lifting while the back is twisted is a common cause. Muscle overuse from exercise also causes strained back muscles.
    • Pain is not the only symptom. Walking a little bent over or stiff may occur for a few days.
    • Here is some care advice that should help.
  2. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
    • Reason: Helps back pain and muscle spasms.
  3. Cold Pack for Pain:
    • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
    • Put it on the sore muscles for 20 minutes.
    • Repeat 4 times on the first day, then as needed.
    • Reason: Helps with the pain and muscle spasms.
    • Caution: Avoid frostbite.
  4. Use Heat After 48 Hours:
    • If pain lasts over 2 days, put heat on the sore muscle.
    • Use a heat pack, heating pad or warm wet washcloth.
    • Do this for 10 minutes, then as needed.
    • Reason: Increase blood flow and improve healing.
    • Caution: Avoid burns.
  5. Sleep on the Side:
    • Sleep on the side with a pillow between the knees.
    • If your child only sleeps on the back, put a pillow under the knees.
    • Avoid sleeping on the stomach.
    • The mattress should be firm. Do not sleep on a waterbed.
  6. Activity:
    • Avoid any sports or work that increase the pain.
    • Avoid lifting or jumping until well.
    • After 48 hours, start gentle back stretching exercises.
    • Complete bed rest is not needed.
  7. Prevent Backpack Pain:
    • Limit the weight of what is carried. It needs to less than 15% of body weight. That means a 100-pound (45 kg) child should not carry more than 15 pounds (7 kg).
    • A sign of carrying too much weight is having to lean forward when walking.
    • Buy a well-made backpack with wide, padded shoulder straps.
    • Never carry the pack on just one shoulder. Reason: causes shoulder and neck pain.
  8. What to Expect:
    • New back pain without a reason most often goes away in a few days.
    • Back pain from muscle overuse (strained back muscles) goes away in 1 to 2 weeks.
  9. Call Your Doctor If:
    • Pain becomes severe
    • Walks different than normal for more than 3 days
    • Pain starts to shoot into the leg
    • Fever occurs
    • Pain lasts more than 2 weeks
    • You think your child needs to be seen
    • Pain gets worse

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

And when in doubt, call your child's doctor NOW or go to the closest emergency department.

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Copyright 2000-2018. Schmitt Pediatric Guidelines LLC.

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