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by Dr. David Borenstein M.D. updated 09/21​

When you drive past the kids waiting for the school bus, you see them with backpacks slung over their shoulders. Some seem to be big enough to weigh the same amount as the child carrying them. It would seem that this mismatch would put children at risk for developing low back pain. The general recommendation is that the backpack should be a safe load and should weigh between 5 to 20% of body weight of the corresponding child.1-2 But is this corroborated by clinical studies?

A systematic review was completed of 69 studies, where 5 were completed prospectively.3 The studies looked at the weight carried and the manner in which they were held. A total of 2897 young students were studied. The overall conclusion was that the weight and carriage of backpacks was not associated with the onset of low back pain. However, the largest study of 1376 students found a two to threefold increase in the risk of persistent low back pain in those children who reported difficulty carrying their schoolbag.4 Overall, the authors remark that most of the studies were of low quality so the results of the studies are not conclusive.

The most important point of the paper is that children can develop low back pain. A multinational study reported that aged 11 had 27%, age 13 had 37%, and age 15 had 47%.5 Back pain affects a significant number of children. The weight of a backpack may affect that number with this problem.

Children should wear a backpack appropriately. They should carry what is necessary. Carrying some weight may be a form of exercise, but they should find other ways to stay active.

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1.Rateau MR. Use of backpacks in children and adolescents. A potential contributor of back pain. Orthop Nurs 2004;23:101-5

  1. Dockrell S. et al. Schoolbag weight limit:can it be defined? J Sch Health 2013;83:368-377
  2. Yamato TP et al. Do schoolbags cause back pain in children and adolescents? A systematic review. Br J Sports Med 2018;0:1-6.doi:10.1136/bjsports-2017-098927

4.Jones GT, MacFarlane GJ. Predicting persistent low back pain in schoolchildren: a prospective cohort study. Arthritis Rheum 2009;61:1139-1366

  1. Swain MS et al. An international survey of pain in adolescents. BMC Public Health 2014;14:447