Sunday, September 21, 2014
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Kids and heavy backpacks: A prescription for back pain

To avoid back pain later in life, a child's loaded backpack should weigh no more than 10 to 20 percent of a child's body weight. Many children are carrying more than they should due to heavier textbooks and laptops.

Kids and heavy backpacks: A prescription for back pain

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Looking inside your child’s backpack may feel like looking at what “Toy Story’s” Mrs. Potato Head packs inside Mr. Potato Head for his trip:  An extra pair of shoes. His angry eyes, just in case. Some Cheese Puffs (if he gets hungry). A key (unknown purpose for it). A Golf Ball (if he has time to play golf). A Plastic Steak. A Rubber Ducky. A Yo Yo. An extra bouncy bouncy ball. Extra teeth (which chatter). Crayons (if he gets bored). A huge lump of blue Play-Doh. A dime to call her and… Monkey Chow (for the Barrel of Monkeys!)

Unfortunately, what’s inside our children’s backpacks weighs much more than all of that put together.

Backpack stats:

  • More than 79 million students in the United States carry backpacks.
  • Young children sometimes carry as much as 22 percent of their body weight. This means that a 60-pound child might be carrying a pack weighing more than 13 pounds!
  • Today’s textbooks are heavier than they used to be as they have more pictures, charts and graphs. (A hardcover book generally weighs 2-7 pounds.)
  • Today’s students often need to carry textbooks and a laptop. (A laptop usually weighs 5-8 pounds.)
  • Many high school students don’t use lockers so they’re carrying their backpacks with them all day.
  • Many students carry their backpacks on one shoulder, which increases the physical stress.

Back pain and backpacks often go hand in hand:

  • In one study with students aged 11 to 15 years, 64 percent reported back pain related to heavy backpacks, and 21 percent reported the pain lasting more than six months. That would mean beyond the month of March in the school year!
  • In a study by Boston University, approximately 85 percent of university students reported discomfort and pain associated with backpack usage.

More coverage
 
Treating and dealing with back pain
Most studies about back pain and backpacks are based on what teenagers report and not on “hard scientific studies.” Because of this, the association between back pain and backpacks is often controversial — like many other issues in medicine (just read my other blogs!).

Until 2009, when medical researchers showed compressed and “out-of-whack” spines resulting from heavy backpacks. The research group used MRIs to look at lumbar spine (lower back) changes in children from backpack loads. They measured the lumbar spine response in healthy children to typical school backpack loads. Three boys and five girls aged 9 to 13 years had MRI scans of the lumbar spine while standing with backpack loads that were approximately 10 percent, 20 percent or 30 percent of each child's body weight. Heavier backpack loads significantly compressed their lumbar discs (the “shock absorbers” between the vertebrae) and increased lumbar asymmetry (abnormal curve in the spine) more than lighter ones. So it’s no surprise that the children reported significant increases in back pain associated with heavier loads!

My advice:

Step 1: Weigh your child’s backpack. The American Academy of Pediatrics recommends that a child’s loaded backpack weigh no more than 10-20 percent of a child’s body weight (and many experts say 10 percent, tops).

Step 2: Help them learn to carry their backpacks correctly. Here’s how: The height of the backpack should extend from approximately two inches below the shoulder blades to waist level or slightly above the waist. The backpack should have wide, padded shoulder straps. Kids should always wear the backpack on both shoulders so the weight is evenly distributed. 

Step 3: Consider moving to Georgia or California, which are the only two states that passed legislation limiting the size and weight of textbooks.

Step 4: Just kidding about Step 3.  But in the spirit of “Toy Story,” lighten up (kids’ backpacks, that is)!


Have a question for the Healthy Kids panel? Ask it here. Read more from the Healthy Kids blog »

Rima Himelstein, M.D. Crozer-Keystone Health System
About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, M.D., Ph.D Jefferson Medical College
Mario Cruz, M.D. St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, M.D., Ph.D Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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