 Introduction/Background It is now generally accepted that nontraumatic back pain in the pediatric population is common. Evaluation of the spine in the setting of trauma will be addressed with a forthcoming ACR Appropriateness Criteria guideline. Early studies have reported prevalence as low as 2%, with more recent evidence suggesting that up to half of the pediatric population experiences back pain [1]. The incidence of back pain increases throughout childhood, most notably lower back pain [2]. Childhood back pain may be predictive of adult back pain [2]. Female sex, poor general health, high level of activity, backpack loads, and family history of back pain are risk factors that have been suggested [3]. Most pediatric back pain is mechanical and responds to conservative treatment with imaging not required in the clinical evaluation [1,4-6]. However, back pain may be caused by more serious conditions, including the broad categories of traumatic, infectious, inflammatory, congenital, and neoplastic processes [7,8]. Evaluation of scoliosis associated with pain will be addressed under a separate ACR Appropriateness Criteria guideline. Back pain is common in the pediatric athlete, with many potential etiologies [9]. The presence of isolated back pain in a child has previously been an indication for imaging; however, recently a more conservative approach has been suggested. As in adults, a diagnostic algorithm is suggested for evaluation of children with back pain in order to reduce the number of unnecessary examinations performed and resultant radiation exposure [10]. Children with back pain of short duration, a normal physical examination, and minor or no history of trauma will likely benefit little from further laboratory or imaging evaluation [1,8,11]. Imaging should be reserved for the presence of persistent back pain with concerning clinical and laboratory findings.
Back Pain Child PCAs.  Introduction/Background It is now generally accepted that nontraumatic back pain in the pediatric population is common. Evaluation of the spine in the setting of trauma will be addressed with a forthcoming ACR Appropriateness Criteria guideline. Early studies have reported prevalence as low as 2%, with more recent evidence suggesting that up to half of the pediatric population experiences back pain [1]. The incidence of back pain increases throughout childhood, most notably lower back pain [2]. Childhood back pain may be predictive of adult back pain [2]. Female sex, poor general health, high level of activity, backpack loads, and family history of back pain are risk factors that have been suggested [3]. Most pediatric back pain is mechanical and responds to conservative treatment with imaging not required in the clinical evaluation [1,4-6]. However, back pain may be caused by more serious conditions, including the broad categories of traumatic, infectious, inflammatory, congenital, and neoplastic processes [7,8]. Evaluation of scoliosis associated with pain will be addressed under a separate ACR Appropriateness Criteria guideline. Back pain is common in the pediatric athlete, with many potential etiologies [9]. The presence of isolated back pain in a child has previously been an indication for imaging; however, recently a more conservative approach has been suggested. As in adults, a diagnostic algorithm is suggested for evaluation of children with back pain in order to reduce the number of unnecessary examinations performed and resultant radiation exposure [10]. Children with back pain of short duration, a normal physical examination, and minor or no history of trauma will likely benefit little from further laboratory or imaging evaluation [1,8,11]. Imaging should be reserved for the presence of persistent back pain with concerning clinical and laboratory findings.