Backpacks in children.

Back pain and deformity are common in adolescents. There has been extensive discussion in the lay literature as to the potential for back pain and spinal deformity with backpack use. The scientific literature on this subject is sparse but is increasing. Epidemiologic studies have identified risk factors associated with back pain in adolescents and daily use of a heavy backpack may be important. A book bag weighing more than 15% to 20% of a child's weight is associated with back pain, and improper use of the backpack can result in changes of posture and gait. There is no evidence that structural spinal deformity can result from backpack use. Children who experience back pain are at increased risk of having back pain as adults. The economic impact may be significant, because back pain is a major cause of disability in adults. The current authors review the available scientific literature and comments on this public health issue.