management Plain film radiographs are the starting point for most conditions that present with back pain which require imaging Anterior–posterior and lateral views of the spine will diagnose fractures, bony tumors, scoliosis, kyphosis, and lordosis Oblique views provide superior views of the pars interarticularis and can diagnose spondylolysis or spondylolisthesis However, given the low sensitivity of plain films, advanced imaging is often indicated if clinical suspicion is high Computed tomography is indicated for evaluation of acute, high-force trauma to the back, otherwise, MRI is often the study of choice The urgency of obtaining an MRI depends on the type and severity of symptoms, the presence of neurologic findings on examination, and concerning labs or plain films MRI is extremely sensitive for spinal cord lesions, osteomyelitis, discitis, and vertebral fractures Back pain in children deserves a careful and comprehensive evaluation Management of back pain in children and adolescents depends upon the specific etiology Nonsteroidal anti-inflammatory drugs are first-line treatment of nonspecific low back pain Because back pain is a relatively uncommon chief complaint and there is potential for significant pathology, close follow-up of patients, especially younger children, presenting with back pain should be ensured Suggested Readings and Key References Brooks TM, Friedman LM, Silvis RM, et al Back pain in a pediatric emergency department: etiology and evaluation Pediatr Emerg Care 2018;34(1):e1–e6 MacDonald J, Stuart E, Rodenberg R Musculoskeletal low back pain in schoolaged children: a review JAMA Pediatr 2017;171(3):280–287 Maher C, Underwood M, Buchbinder R Non-specific low back pain Lancet 2017;389(10070):736–747 Nahle IS, Hamam MS, Masrouha KZ, et al Back pain: a puzzle in children J Paediatr Child Health 2016;52(8):802–808