Back pain

Template

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Red flags presentChoose any

Red flags absentChoose any

ExamChoose one

Likely causeChoose one

ImagingChoose one

LabsChoose any

PlanChoose any

SportsChoose any

ReferralChoose any

DispositionChoose one

Follow-upChoose one

Counseling

Most back pain in older children and teens is not serious and improves over a few weeks with activity and strengthening. Recommended supportive care with heat or ice and tylenol or motrin as needed for pain, with an emphasis on staying active and core strengthening. Return precautions given including fever, night pain, weakness or numbness in the legs, trouble controlling urine or stool, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Back pain
• No fever or chills, weight loss, night pain, unrelenting pain, or neurologic or bowel or bladder symptoms
• Normal neurologic exam
• Likely muscular back pain
• No imaging needed given a reassuring exam
• Stay active in activities that do not cause pain, with core strengthening and stretching
• Physical therapy referral
• Follow up if worsening or not improving

Most back pain in older children and teens is not serious and improves over a few weeks with activity and strengthening. Recommended supportive care with heat or ice and tylenol or motrin as needed for pain, with an emphasis on staying active and core strengthening. Return precautions given including fever, night pain, weakness or numbness in the legs, trouble controlling urine or stool, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Red flags present or absent
Muscular vs spondylolysis
Rest from sports for spondylolysis
Cord compression

Return precautions in the template

fevernight painweakness or numbness in the legstrouble controlling urine or stoolpain that keeps getting worse

Sources

Sport-Related Concussion in Children and Adolescents. Clinical Report. Pediatrics 2018;142(6):e20183074. (newest AAP concussion CR found; also Early Childhood…
Overuse Injuries, Overtraining, and Burnout in Young Athletes. Clinical Report. Pediatrics 2024;153(2):e2023065129. (replaces earlier report)
Early Childhood Concussion. State-of-the-art review. Pediatrics 2024;154(5):e2023065484 (not an AAP policy)

Few formal guidelines cover this topic, so the template also leans on expert opinion.