This 2016 JAAOS narrative review by Shah and Saller systematically addresses the evaluation and diagnosis of back pain in children and adolescents, covering epidemiology, red-flag identification, imaging strategy, and condition-specific workup for the most common organic and nonorganic etiologies.
When a child under 10 or any adolescent presents with back pain accompanied by night pain, fever, weight loss, neurologic deficits, or constant pain, treat these as red flags mandating advanced imaging — don't reflexively reassure.
For the majority without red flags, apply the Feldman algorithm to guide imaging selectively, counsel families that nonorganic etiology is common, and initiate physical therapy before ordering MRI or CT.
This 2016 JAAOS narrative review by Shah and Saller systematically addresses the evaluation and diagnosis of back pain in children and adolescents, covering epidemiology, red-flag identification, imaging strategy, and condition-specific workup for the most common organic and nonorganic etiologies.
When a child under 10 or any adolescent presents with back pain accompanied by night pain, fever, weight loss, neurologic deficits, or constant pain, treat these as red flags mandating advanced imaging — don't reflexively reassure.
For the majority without red flags, apply the Feldman algorithm to guide imaging selectively, counsel families that nonorganic etiology is common, and initiate physical therapy before ordering MRI or CT.