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Fifteen-minute consultation: a structured approach to the management of a child or adolescent with back pain
  1. Mary Cruikshank1,
  2. Athimalaipet V Ramanan2
  1. 1Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
  2. 2Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
  1. Correspondence to Dr Athimalaipet V Ramanan, Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK; avramanan{at}


Back pain in childhood is relatively unusual, although as a child matures through adolescence it becomes much more common. At any age, potentially serious illnesses need to be excluded. There are some useful red flags to be aware of when taking a history and performing an examination. We outline a systematic approach when faced with this clinical presentation in a general paediatric setting, with suggestions for initial investigations and when to consider referral to a specialist.

Objective To provide a structured approach for the paediatrician to appropriately manage a child or adolescent who presents with back pain.

Method Review of the literature and description of the approach commonly adopted in a paediatric setting. Extended matching case questions are used to help the reader test their understanding.

Conclusions A focused history, specifically asking about red flags, and a careful examination are essential to reach an appropriate differential diagnosis and management plan. Onward referral to a specialist may be required.

  • Orthopaedics
  • Rheumatology
  • Bone Disease
  • General Paediatrics

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