The use of backpacks during the school day and backpack weights are independently associated with back pain.

Back pain and deformity are common in adolescents. There has been extensive discussion in the lay literature as to the potential for back pain and spinal deformity with backpack use. The scientific literature on this subject is sparse but is increasing. Epidemiologic studies have identified risk factors associated with back pain in adolescents and daily use of a heavy backpack may be important. A book bag weighing more than 15% to 20% of a child's weight is associated with back pain, and improper use of the backpack can result in changes of posture and gait. There is no evidence that structural spinal deformity can result from backpack use. Children who experience back pain are at increased risk of having back pain as adults. The economic impact may be significant, because back pain is a major cause of disability in adults. The current authors review the available scientific literature and comments on this public health issue.

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Casts are commonly used for fracture management and postoperative immobilization in pediatric patients. However, cast immobilization is not without complications (eg, thermal injuries, pressure sores, infection, and neurovascular injury) and may be associated with additional costs and increased loss of school/work days for cast removal or other complications. The disadvantages of traditional casting can be minimized by alternative management strategies: waterproof casts to facilitate bathing and swimming; a Pavlik harness in infants, a single-leg spica cast, or flexible intramedullary nails to avoid complications with double-leg spica casts for femur fractures; and braces or splints to manage buckle and minimally displaced distal radius fractures, toddler's fractures, and stable foot/ankle fractures.