History Evaluation of the Child or Adolescent with Back Pain Including Ten Red Flags

Back pain in the child or adolescent patient is one of the most common reasons for physician assessment and referral. Back pain prevalence in the teenage years has been purported in the literature as high as 35% (Joergensen et al., Eur J Pediatr 178:695–706, 2019). Although the majority of time it is musculoskeletal in nature and self-remitting, it still necessitates a thorough evaluation to rule out disorders that can result in significant disability, such as infection or tumor. Back pain itself should not be construed as a diagnosis, but rather a symptom of some underlying process. The physician should be able to take a thorough and detailed history to help direct for further diagnostic modalities as part of the workup. Activity modifications, exercises, rehabilitation, and management of emotional stressors can prevent recurrent episodes for most cases of musculoskeletal back pain. However, in cases of severe and persistent back pain, a thorough history combined with a detailed physical exam and appropriate imaging studies is necessary to determine if serious underlying pathology is to blame.