Dear Doctor Column, August 7, 2006
Backpacks and Back Pain in Children
Question:
My daughter and I are going shopping for back-to-school supplies. What's the best way to choose a backpack so she won't strain her back?
Answer:
Backpacks are popular with students of all ages, come in a variety of colors, fabrics, and designs, and are a practical way for children and teenagers to carry books and supplies. As long as the backpack meets certain basic requirements and your child packs and carries it properly, you can let her express herself and choose the backpack that most appeals to her (and fits your budget).
When worn and packed correctly, backpacks evenly distribute weight to back and stomach muscles— the body's strongest muscles. When the weight is unbalanced or too heavy, the load affects your child's posture, pulling her backward. Children compensate by bending forward at hips or arching their back. This can compress the spine and may injure muscles and joints and lead to severe back, neck, and shoulder pain, according to the American Academy of Pediatrics (AAP). Some studies show an estimated 50% of 15- to 16-year-olds suffer from back pain, which can be caused by a number of factors, including improperly selected or improper use of backpacks.
Wearing a backpack over just one shoulder, a look some children think is cool, also is a bad idea. The off-balance load can cause the wearer to lean to one side to make up for the extra weight, and this can strain the neck and shoulders and lead to back pain. If your child struggles to get her backpack on or off, has back pain, or is hunched over as she heads out the door in the mornings, her pack is probably too heavy, worn incorrectly, or both.
The AAP recommends that children carry no more than 10% to 15% of their body weight in their backpacks. That means an 80-pound child shouldn't carry a backpack that weighs more than 8 to 12 pounds. Because girls and younger children often weigh less than boys or older kids, they may be more likely to carry loads that are inappropriate for their body weight.
The AAP and the American Occupational Therapy Association (AOTA) offers these suggestions for choosing the right backpack. Look for the following:
- Lightweight backpack. The backpack itself should not add much weight to the load. The bottom of the pack should rest in the curve of the lower back.
- Wide, padded shoulder straps. Narrow straps can dig into shoulders causing pain and restricting circulation.
- Two shoulder straps. Backpacks with one shoulder strap that runs across the body cannot distribute weight evenly.
- Padded back. A padded back protects against sharp edges of objects inside the pack and is more comfortable.
- Waist belt and multiple compartments, which help distribute the weight of a heavy load more evenly.
- Rolling backpack. If your child's school allows it, this type of backpack may be a good choice for students who must tote a heavy load. Remember that children still have to carry rolling backpacks up stairs.
To prevent injury when using a backpack, the AAP and AOTA recommend the following:
- Pack light. As noted, backpacks should never weigh more than 10% to 15% of your child's total body weight. Make sure your child is only taking what she needs for her school day — extra clothes and unneeded electronics add unnecessary pounds.
- Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back and arrange books and materials so they won't slide around in the backpack. On days the backpack is overloaded, your child can hand carry a book or other item.
- Always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles and may increase curvature of the spine.
- Tighten the straps so the pack is close to the body. The straps should hold the pack 2 inches above the waist.
- Bend using both knees. Don't bend at the waist when wearing or lifting a heavy backpack. Teaching your child to lift heavy objects properly can help avoid back injuries.