Nocturnal Back Pain In Children – What You Should Know

There are many reasons why a child may complain of back pain or discomfort, including muscular injuries, poor posture, and carrying heavy school bags.

Introduction

The condition affects around 30% of the population, usually girls more than boys, but is not considered a serious problem.<a href="#accordion">[4]</a> This is probably because the pain tends to subside on its own in the majority of cases, and very few individuals actually consult a doctor for pediatric back pain.

However, if the back pain has been going on for a long period and worsens with time, if disturbs your child&rsquo;s sleep at night, and if it causes them to have a stiff back in the morning, then it is a cause for concern. 
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Here&rsquo;s what you need to know about nocturnal back pain in children.

Understanding nocturnal back pain in children

A recent study established that there are associations between inflammation, nocturnal back pain, and fatigue in conditions such as ankylosing spondylitis.<a href="#accordion">[3]</a>

Juvenile ankylosing spondylitis manifests around 6-12 years of age, mostly affecting girls after puberty and boys before puberty. The pain especially disturbs sleep during the second half of the night.<a href="#accordion">[5] </a>Hence, the decrease in nocturnal back pain was shown to improve fatigue. 
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Research also shows it is more likely for children to inherit chronic back pain than acute back pain due to genes expressed in the central nervous system.<a href="#accordion">[2]</a> 
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<h5>Important!</h5>

Consult a doctor immediately if your child:

<ul>
	<li>Is 4 years old or younger</li>
	<li>Is unable to do anything due to stiffness or difficulty moving</li>
	<li>Has had back pain for more than 4 weeks</li>
	<li>Presents with unintentional weight loss, loss of appetite, and a general feeling of malaise</li>
	<li>Experiences numbness or weakness</li>
	<li>Experiences a growth spurt and develops a spine curvature 
	&nbsp;</li>
</ul>

It&rsquo;s important to thoroughly evaluate and proceed with appropriate imaging studies in children presenting to the emergency department with back pain.<a href="#accordion">[1]</a> This is important because subjecting children to scans, like MRI, CT, and X-rays, is not only unpleasant, but it also means exposure to a high dose of radiation. 
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Here&rsquo;s what you can look out for in children with back pain:

<ul>
	<li>A muscular strain particularly affects the lower back, sometimes going down the hips and back of the thigh, and worsens when the child stretches, bends, coughs, or sneezes.</li>
	<li>Common symptoms of a spinal fracture or malformation include back pain, which is aggravated by sitting, standing, bending, or twisting and alleviated by rest. It may be accompanied by tingling, numbness, weakness, difficulty walking, and bladder or bowel problems.</li>
	<li>A stress fracture or inflammatory arthritis may lack any physical signs.</li>
	<li>Degenerative spinal issues like kyphosis and scoliosis may present with a noticeable deformity of the spine.</li>
	<li>In rare instances, children who feel unwell for more than 2 weeks, experience weight loss, or are unable to sleep at night due to pain may be diagnosed with a tumor such as osteoid osteoma. The pain typically affects the middle or lower back. It is also constant and unrelated to activity.</li>
	<li>Another rare cause of back pain in children is infection of the disc or bone in the spine, which causes generalized pain and fever. 
	&nbsp;</li>
</ul>

Conclusion

Back pain at night in children is a multifaceted issue that requires a comprehensive understanding of its associations to ensure early intervention and management. Long-term back pain can affect their overall well-being, leading to disability and depression, for instance. Addressing this issue necessitates a holistic approach to prevent the child from developing any complications. 
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Key Takeaways

<ul>
	<li>One of the types of back pain in children is nighttime back pain.</li>
	<li>Frequent pain that awakens the individual child at night is related to infections or tumors, including aneurysmal bone cyst, discitis, Ewing&rsquo;s sarcoma, osteoblastoma, osteomyelitis, leukemia, osteoid osteoma, eosinophilic granuloma, and spinal cord tumors.</li>
	<li>Immediate medical attention is crucial for nighttime back pain in children.</li>
</ul>

[1] Bhatia, N., Chow, G., Timon, S., & Watts, H. (2008). Diagnostic modalities for the evaluation of pediatric back pain. Journal of Pediatric Orthopaedics, 28(2), 230-233.

[2] Bortsov, A., Parisien, M., Khoury, S., Zaykin, D., Martinsen, A., Lie, M., … & Diatchenko, L. (2020). Genome-wide analysis identifies significant contribution of brain-expressed genes in chronic, but not acute, back pain.

[3] Hammoudeh, M., Zack, D., Li, W., Stewart, V., & Koenig, A. (2013). Associations between inflammation, nocturnal back pain and fatigue in ankylosing spondylitis and improvements with etanercept therapy. Journal of International Medical Research, 41(4), 1150-1159.

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