• Point tenderness back pain: spondylolysis, diskitis, or a tumor.
• If hurt at night, worse enough to wake child up or the pain is getting worse, you should order a MRI of the cervicothoracic lumbar spine.

• If the child had a lumbar puncture, because sometimes a little skin gets into the spinal canal and can cause an epidermoid cyst.
• Heavy backpacks also can be associated with back pain.
• Yoga and Pilates, gym for personal strength training.
• I generally tell them, ‘I want you to do this 3 times a week for the next 50 years.’ It's a little bit of a joke, but that's true; that's what we have to do to keep ourselves out of back pain.”

Spinal problems that can occur in children:

Congenital muscular torticollis.

• The cause is thought to be fibrosis or compartment syndrome of the sternocleidomastoid muscle.
• “Oftentimes, when the kids are born they may not have this position, but within a few weeks, it develops,” Dr. Skaggs said. “That's because it takes a while for the sternocleidomastoid muscle to fibrose or develop compartment sydrome after the trauma of birth.”
• Physical therapy is begun in a timely fashion, the condition remits > 95% of the time within the first year of life.
• 5% association with developmental dysplasia of the hip- screen with hip ultrasound

Plagiocephaly

• Usually 2nd to congenital muscular torticollis.
• The best treatment for this is to treat the torticollis.
• “Encourage sleep with the head tilted in the opposite position of normal, and resolve spontaneously
• If the plagiocephaly doesn't resolve in 6–8 months, referral to a neurosurgeon or an expert in bracing is warranted.

Late-onset torticollis

Most commonly due to C1-C2 rotatory subluxation, the sternocleidomastoid muscle is tight on the opposite side to where the ear is toward the chin. It's in spasm from being stretched to accommodate the head position. “Most of the time, it resolves spontaneously in a few days,”
If it doesn't resolve in a week, that means an instant referral to a specialist in pediatric spine disorders.”
Detection after 1 month of onset usually requires surgical fusion.

Assess children for back pain:

• Jump up and down on one foot, then the other.
• Walk on heels with the toes pointed upward. That covers L4 for ankle dorsiflexion. these first two tests covered about all of the strength and balance of the lower extremities,” he said.
• the reflexes, including the umbilicus. If you lightly stroke the umbilicus on either side, the belly button should move to one side or the other. If it doesn't move, that's normal. “But if it's asymmetrical, there's a great chance there's syrinx.”
• Test for ankle clonus. Push up on the ball of the foot and forcibly dorsiflex the ankle. “If it beats once or twice that's normal,” he said. “Three or four beats of clonus and I'd consider a neurological work-up and/or an MRI.”
• Assess hamstring tightness. A popliteal angle up to 30–40 degrees is normal.
• Check the feet. “If you have claw toes or a cavus foot, that's a sign that something neurological is going on in the spine,” he said.