Pain in the Back: Your Child's Backpack May Not be the Cause

Peer Reviewed

Back pain is pervasive throughout the adult population. It is one of the most common reasons to visit a doctor. Young children are suffering from back pain much earlier than previously reported and the use of overweight backpacks is a major contributing factor. In addition to overloaded backpacks, improper wearing of them may predispose a child to various health problems. Back pain usually results from repetitive loading as well as improper mechanics, not to mention kids are getting weaker and less physically active, leading to the child's inability to handle the load of the backpack.
Boy with a hat struggling to carry his heavy backpackDo not carry more than 15 percent of the child's body weight. For example, a child who weighs 100 pounds should not carry more than 15 pounds in his or her backpack. Photo Source:

Does your child complain or exhibit the following signs and symptoms?

  • Aching back
  • Aching neck and shoulders
  • Tingling in the arms and hands
  • Slumped posture: rounded shoulders, forward head
  • Posture changes when wearing a backpack
  • Struggling when putting on or taking off the backpack
  • Redness and/or soreness on the shoulders

Major contributing factors associated with injury:

1. Muscle imbalances: too weak in the abdominal area, shoulder blades, and/or lower body

2. Slumped posture while standing and sitting

3. Posture changes: arching the back, leaning forward, leaning to one side

These factors may cause improper loading on the spine, which in turn can cause poor alignment of the vertebrae, which negatively impacts the function of the discs as shock absorbers. When the backpack is too heavy or positioned poorly, this causes muscles to work harder, leading to strain and fatigue that ultimately makes the back, neck and shoulders more susceptible to injury.

Recommendations to ensure proper and safe backpack use:

1. Do not carry more than 15 percent of the child's body weight. For example, a child who weighs 100 pounds should not carry more than 15 pounds in his or her backpack.

2. Utilize both straps over the shoulders.This provides better distribution of the weight. Make sure the straps are well padded. If the backpack has a waist belt, use it to reduce the load on the shoulders and neck.

3. Load the heaviest items closest to the child's back. Make sure the books and the other materials do not slide around.

4. Make sure the backpack is positioned across the mid back and do not allow it to hang below the waist of the child. Straps should not be loose, and should be adjusted while putting on and taking off to permit free movement of the arms without twisting and side bending the spine.

5. Parents should assist with the loading and the organization of the books and materials. Make sure the items are necessary for each particular day. If necessary, it's OK to have the child hand carry a couple of books.

6. Listen to your child. If he or she continues to complain of pain and discomfort do not shrug it off. There are plenty of things children can do to avoid pain. Have them evaluated by a medical professional.

7. You may consider a backpack with wheels. Make sure the extended handle is the appropriate length to prevent the child from excessively bending and twisting.

8. Be aware of your child's habits and physical make-up. Proper exercise and nutrition are key to preventing injuries immediately, as well as later in life.

The truth is, as kids get stronger and their muscles become more balanced, they will build up tolerance to these and other daily stresses of life. It just takes a little bit of knowledge and coaching from Mom and Dad to encourage your child to become more active in a fun way.

I encourage you to keep in mind what I call "balanced muscle development." It is the key to any and all development. If you are not certain as to how a child can achieve a balanced body, please seek professional help from a certified health care provider.

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Updated on: 09/17/19
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Jean-Jacques Abitbol, MD
Orthopaedic Surgeon
California Spine Group, MC
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