DISORDERS OF THE PEDIATRIC AND ADOLESCENT SPINE
Back Pain in Children
Howard A. King, MDPage: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11
MEDICAL HISTORY
Young children and adolescents may be vague when answering questions regarding their symptoms. They frequently are unable to be specific about details when the usual medical questions are asked. It is therefore important to ask specific questions and even repeat them with different wording to obtain necessary information. It is important, even with adolescents, to have a parent available at the time of the evaluation. With a parent available, more information can be obtained, and better insight regarding the symptoms and how they affect the patient and family may be obtained. The initial evaluation should be in a relaxed and comfortable environment which optimizes the ability to establish good rapport with the patient and family. It is important to observe the interaction of the patient with the family Subtle comments, movements, and gestures may be helpful keys to making the diagnosis.
The history should start with general questions regarding the onset, location, frequency, duration, and intensity of symptoms. Frequently, children and their parents have difficulty in recalling when their symptoms started; therefore, using a reference point, such as the onset of an event, season, or initiation of a new sport or activity, may be useful to differentiate acute symptoms from an insidious onset of symptoms. Patient activity level of sports and others should be assessed. It is not uncommon to find that active youths are involved in two or more sports at a time on several teams all competing at a select or premier level. This information is useful in helping differentiate stress fractures and overuse syndromes. Any abrupt change in activity should be noted as well as any acute event, such as a severe fall, motor vehicle accident, or other traumatic event. It is also appropriate to learn more about how the symptoms are affecting the patient's ability to perform normal activities. If symptoms are present only with home chores it is not as worrisome as if the symptoms interfere with the child's ability to participate in enjoyable sports and activities. Any child forced to stop activities because of back pain needs a thorough evaluation.
It is useful to identify specific movements or activities that aggravate or relieve symptoms. Specific movements in a sport that cause the symptoms (i.e., backhand springs and walk-overs in gymnastics, the butterfly stroke in swimming, hyperextension in football), may more clearly define such problems as spondylolysis and spondylolisthesis.
Night pain is an essential symptom to identify. A patient who is awakened by back painand is unable to return to sleep must be considered to have a tumor, infection, or inflammatory condition until proven otherwise. As a general rule, problems such as spondylolysis, spondylolisthesis, Scheuermann's disease, muscle strain, and overuse problems are made better with rest.