When Is Back Pain in a Child or Teenager a Red Flag?
Most back pain in children and teenagers comes from the muscles. It settles within a few weeks. It becomes a red flag when it wakes a child at night or lasts longer than four weeks. It is also a red flag when it comes with fever, weight loss, or nerve symptoms such as leg weakness or changes in bladder or bowel control. These signs need urgent medical attention.
Get urgent medical help (see your doctor or go to the emergency department) if a child or teenager has back pain with any of these: numbness or weakness in the legs, loss of bladder or bowel control, unexplained fever, night sweats, or sudden severe pain after an injury. Do not wait to book a scan. These symptoms need a doctor straight away.
Key points
- Back pain in children is common. It is usually caused by muscle strain, growth, or poor posture.
- Red flags include night pain, pain lasting over four weeks, fever, weight loss, and nerve symptoms.
- Young athletes are at higher risk of stress-related bone injuries such as spondylolysis.
- If a red flag is present, the child should see a doctor or go to the emergency department before any scan is arranged.
- When a doctor recommends a scan, a standing whole-body assessment can show alignment problems that lying-down scans may miss.
What are the red flags for back pain in children and teenagers?
Red flags are warning signs. They suggest the back pain may have a more serious cause underneath. They help parents and clinicians decide whether a child needs more tests or an urgent medical review.
Pain that wakes a child from sleep is uncommon in simple muscle strain. It can point to infection or a bone lesion.
Pain that does not improve after four weeks of rest needs a medical review.
Whole-body symptoms such as unexplained fever, night sweats, or weight loss may point to infection or another serious condition.
Leg weakness, numbness, changed reflexes, or changes in bladder or bowel control need urgent assessment.
Pain that keeps getting worse, especially in a young child, should always be taken seriously.
Back pain in children under ten is less common. It is more likely to have a structural or medical cause.
What causes back pain in children and teenagers?
The most common causes are linked to muscles and posture. They usually get better with simple changes and do not need a scan.
A bag that is too heavy, or worn on one shoulder, can strain the muscles of the back and shoulders.
Fast growth can tighten muscles and tendons for a while. This causes aches in the back and legs.
Long periods sitting, or bent over a phone or laptop, can overload the upper and lower back.
Repeated training, especially in gymnastics, cricket, or athletics, can overwork the growing spine.
These causes are common and generally harmless. A lighter bag, breaks from screens, and a mix of sports usually help. If pain lasts beyond four weeks or comes with any red flag, the next step is to see your doctor.
Can back pain in a young person be something serious?
Yes, although it is uncommon. When red flags are present, a doctor needs to consider the following conditions.
Spondylolysis (stress fracture)
Spondylolysis is a stress fracture in one of the lower vertebrae. It is most often seen in young athletes whose sport involves repeated bending backwards or twisting, such as gymnastics, fast bowling in cricket, or ballet. Pain typically gets worse with activity and eases with rest.
Scheuermann's kyphosis
Scheuermann's kyphosis causes a rounded upper back during the teenage growth spurt. The front edges of several vertebrae grow more slowly than the back edges. This creates a wedge shape. It can cause stiffness and aching in the middle of the back, especially after sitting.
Infection
Spinal infections (discitis or osteomyelitis) are rare but serious. Warning signs include constant pain that does not ease, fever, and feeling generally unwell. These need urgent medical treatment.
Tumour
Bone tumours in the spine are very rare in children and teenagers. The key warning signs are night pain, unexplained weight loss, and symptoms that keep getting worse. An early check by your doctor is essential.
When should you take a child with back pain to a doctor?
See your doctor if your child's back pain has lasted more than four weeks, is getting worse, or comes with any of the red flags above. Read more about when to see a specialist for further guidance.
- Mild ache after sport that settles in a few days
- Stiffness after a long car journey or school day
- Pain clearly linked to a heavy bag, which eases when the bag is adjusted
- No night pain, no fever, no nerve symptoms
- Pain lasting longer than four weeks
- Pain that wakes the child at night
- Fever, night sweats, or unexplained weight loss
- Leg weakness, numbness, or bladder or bowel changes
- Child under ten with back pain that does not go away
- Pain that keeps getting worse despite rest
How are scans used to look into back pain in young people?
Once a doctor has examined a child and decided a scan is right, the type of scan depends on what they are looking for. Standard lying-down X-rays and MRI are commonly used. But the spine behaves differently when standing under the body's own weight. So alignment problems can be missed when a young person lies flat.
An EOS scan takes a full-length, weight-bearing image of the whole skeleton, from head to feet, while the patient stands naturally. This uses about 90% less radiation than a standard X-ray, around ten times less. For growing bodies, keeping radiation as low as possible matters. ScanAlign, low dose standing imaging, offers paediatric imaging at ScanAlign when a referring clinician or doctor has recommended further assessment.
When MRI is the better choice: EOS shows bones, joints, and alignment. For soft-tissue problems, discs, nerves, or suspected infection, MRI is usually the better tool. Your child's doctor will advise which scan suits them best.
Before your child starts treatment, or changes the one they are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.
Frequently asked questions
Mild, short-lived back pain is fairly common in teenagers, especially during growth spurts or after sport. It usually settles on its own. Pain that lasts more than four weeks, or comes with red-flag symptoms, should be checked by a doctor.
Pain that regularly wakes a child from sleep is a recognised red flag. It does not always mean something serious. But it does mean the child should see a doctor promptly.
Yes. A bag that weighs more than about 10 to 15 per cent of a child's body weight, or is carried on one shoulder, can strain the back and shoulders. Using both straps and lightening the load usually helps.
Spondylolysis is a stress fracture in one of the lower vertebrae. It is more common in young athletes whose sport involves repeated extension or rotation of the spine. A doctor can arrange a scan to confirm it.
If the pain has not improved after four weeks, or is getting worse, the child should see a doctor. Any red-flag symptom at any point, such as fever, nerve changes, or night pain, means you should get medical advice sooner.
A referral from a doctor or specialist is not always needed. But for children and teenagers, ScanAlign recommends that a clinician has first examined the child and agreed that a scan is appropriate. You can book a paediatric assessment to discuss the next steps.
An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. For growing children, this low dose is an important advantage.
Scheuermann's disease (also called Scheuermann's kyphosis) causes a rounded upper back during the teenage years. Several vertebrae develop a wedge shape as the front edges grow more slowly. It can cause stiffness and aching, particularly after sitting for long periods.
When lying down, the muscles relax and the spine carries no load. This can hide alignment problems that only show when standing and bearing weight. A standing whole-body image shows the skeleton as it actually works during the day.
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- NHS. "Back pain in children." nhs.uk. Accessed 2024.
- MacDonald J, Stuart E, Rodenberg R. "Musculoskeletal Low Back Pain in School-Aged Children." JAMA Pediatrics, 2017; 171(3): 280-287.
- National Institute for Health and Care Excellence (NICE). "Suspected cancer: recognition and referral (NG12)." nice.org.uk. Updated 2023.
Written by Abbas Dhami (Specialist Diagnostic Radiographer).
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.