Like little sherpas, schoolchildren each day dutifully tote their backpacks, stuffed with books and papers and a kid's daily necessities.
But these overstuffed packs may play a role in childhood back pain.
According to Duke pediatric rheumatologist Dr. Laura Schanberg, "In our practice, the use of backpacks is a frequent cause of thoracic back pain, particularly in adolescent girls."
Dr. Egla Rabinovich also a pediatric rheumatologist at Duke, says that while the relationship between backpacks and back pain in children is debated, parents and pediatricians should take steps to address potential problems.
She recommends encouraging children to carry only the books and supplies they absolutely need, and to use both shoulder straps. Some schools are aware of the problem and are helping by supplying kids with two copies of each book -- one for school and one for home.
"Unfortunately, it is uncool to have a wheeled backpack, but they would solve so many problems," says Rabinovich. "These packs can be 40 pounds and more."
In addition to backpacks, poor posture and even stress are common causes of back pain in children.
"You know the knots you get in your back when you're stressed? Kids get that, too," Rabinovich says.
Fortunately, she adds, such back pain is benign and can be alleviated by addressing the source of the problem.
In rare cases, childhood back pain could be caused by a variety of more serious conditions including: arthritis, cancer, congenital spine deformity and tumors.
When should a parent be concerned that the problem may not just be mechanical?
According to Rabinovich, parents should talk to their pediatrician or family practitioner when back pain is accompanied by weight loss, fever, looking pale, and having pain even when at rest.
For more tips and advice from Duke Medicine, go to the Health Library on dukehealth.org.