Back pain in children.

Pay attention to back pain reported by children. Half will have a specific or serious cause, the presenting symptoms of serious conditions may be misleadingly mild, and the spectrum of causes and mode of presentation differ from adults. Warning features include onset aged < 4 yr, symptoms persisting beyond 4 weeks, interference with function, systemic features, worsening pain, neurological features and recent onset of scoliosis. Scintigraphy is often useful where clinical features and plain radiographs fail to identify the diagnosis. Sports activities may cause stress reactions in the immature spine, particularly at the junction between spinal segments of differing mobility, the vascularity of the disc and vertebra predisposes to infection, spinal tumours presenting as pain tend to be primary and benign, congenital spinal anomalies causing pain tend to present in childhood, spondylitis presents differently from adults, and conversion hysteria, typically presenting with gross, bizarre and disabling symptoms, is not uncommon in adolescent girls.