Table 1:

Symptoms and signs that may indicate serious underlying pathology in children with back pain—red flags

HistoryExamination
Prepubertal children especially <5 yearsFever, tachycardia
Functional disabilityWeight loss, bruising, lymphadenopathy, or abdominal mass
Duration >4 weeksAltered spine shape or mobility
Recurrent or worsening painVertebral or intervertebral tenderness
Early morning stiffness and/or gellingLimp or altered gait
Night painNeurologic symptoms
Fever, weight loss, malaiseBladder or bowel dysfunction
Postural changes: kyphosis or scoliosis
Limp or altered gait
  • Reproduced with permission from BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.15