When Is Back Pain in a Child or Teenager a Red Flag?
Most back pain in children and teenagers is muscular and settles within a few weeks. It becomes a red flag when it wakes a child at night, lasts longer than four weeks, comes with fever, weight loss, or neurological symptoms such as leg weakness or changes in bladder or bowel control. These signs need urgent medical attention.
Seek urgent medical help (GP, 111, or A&E) if a child or teenager has back pain with any of the following: 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 imaging. These symptoms need a doctor straight away.
Key takeaways
- Back pain in children is common and usually caused by muscle strain, growth, or poor posture.
- Red flags include night pain, pain lasting over four weeks, fever, weight loss, and neurological 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 GP or attend A&E before any imaging is arranged.
- When a doctor recommends imaging, standing whole-body assessment can reveal 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 that suggest back pain may have a more serious underlying cause. They help parents and clinicians decide whether a child needs further investigation or urgent medical review.
Pain that wakes a child from sleep is uncommon in simple muscle strain and can point to infection or a bone lesion.
Pain that does not improve after four weeks of rest warrants a medical review.
Systemic symptoms such as unexplained fever, night sweats, or weight loss may indicate infection or another serious condition.
Leg weakness, numbness, altered reflexes, or changes in bladder or bowel control require urgent assessment.
Pain that progressively worsens, especially in a young child, should always be taken seriously.
Back pain in children under ten is less common and more likely to have a structural or medical cause.
What causes back pain in children and teenagers?
The most common causes are muscular and posture-related. They usually respond to simple changes and do not need imaging.
A bag that is too heavy or worn on one shoulder can strain the muscles of the back and shoulders.
Rapid growth can temporarily tighten muscles and tendons, causing aches in the back and legs.
Long periods sitting or hunched over a phone or laptop can overload the upper and lower back.
Repetitive training, especially in gymnastics, cricket, or athletics, can overwork the growing spine.
These causes are common and generally harmless. Adjusting bag weight, encouraging breaks from screens, and varying sporting activities usually helps. If pain persists beyond four weeks or is accompanied by any red flag, the next step is a GP appointment.
Can back pain in a young person be something serious?
Yes, although it is uncommon. When red flags are present, the following conditions need to be considered by a doctor.
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 worsens 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, creating a wedge shape. It can cause stiffness and aching in the mid-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, but night pain, unexplained weight loss, and progressive symptoms are the key warning signs. Early GP assessment is essential.
When should you take a child with back pain to a doctor?
You should see a GP if your child's back pain has lasted more than four weeks, is getting worse, or is accompanied by any of the red flags listed 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, eased by adjusting it
- No night pain, no fever, no neurological 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/bowel changes
- Child under ten with persistent back pain
- Progressive worsening despite rest
How is back pain in young people investigated with imaging?
When a doctor has assessed a child and decided imaging is appropriate, the type of scan depends on what is being looked for. Standard lying-down X-rays and MRI are commonly used. However, because the spine behaves differently when standing under the body's own weight, alignment problems can be missed when a young person is lying 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 in cases where a referring clinician or GP 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 is most appropriate.
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 is accompanied by red-flag symptoms should be assessed 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 be seen by a GP 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 imaging to confirm it.
If the pain has not improved after four weeks, or is worsening, the child should see a GP. Any red-flag symptom at any point, such as fever, neurological changes, or night pain, means you should seek medical advice sooner.
A GP or specialist referral is not always required, but for children and teenagers, ScanAlign recommends that a clinician has first assessed the child and agreed that imaging 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, muscles relax and the spine is unloaded. This can mask alignment problems that only appear when standing and bearing weight. A standing whole-body image shows the skeleton as it actually functions during the day.
Pricing details are available on the ScanAlign website. You can also discuss costs during a free video consultation before committing to anything.
Have questions about your child's back pain?
If a doctor has assessed your child and recommended imaging, our team can explain whether a standing whole-body scan would add useful information.
Book a free video consultationSources
- 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.