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Is my child's backpack too heavy?

By Pierre d'Hemecourt, MD, Children's Hospital Boston Division of Sports Medicine

It's become an all-too-common sight: small children bent over from the weight of giant backpacks filled with heavy books, notepads and other assorted school supplies. According to some studies, many kids carry bags that are equal to 30 percent of their body weight. Pierre D'Hemecourt, MD, sports medicine specialist at Children's Hospital Boston, shares the following information about the risks associated with heavy backpacks—and how to avoid them.

Can heavy backpacks cause back problems for my child?
This issue is a bit controversial, as there's no proof that backpacks specifically cause children's back problems. However, the American Academy of Orthopedic Surgeons and the American Physical Therapy Association have set guidelines that should be followed with backpacks to reduce the potential risks associated with them. During adolescence, children go through growth spurts, and their bones and posture are susceptible to injury, possibly from heavy backpacks.

What problems could be caused by heavy backpacks?
One problem seen in 4 to 6 percent of school children complaining of back pain is spondylolysis, which is a stress fracture in the back that can be treated with anti-inflammatory medications. Children also experience apophysitis, which is an inflammation of growth cartilage, often in the heel, that's generally treated with rest, a brace and stretching exercises.

Children also might experience posture problems because with a heavy backpack many end up leaning too far forward, rolling their shoulders and causing a more rounded upper-back. They then tilt their head up to see properly, which strains the back and neck muscles and can cause nerve damage in the neck.

Children might also lean backward from the weight, which can alter the sway of the back and cause stress fractures in the spine. If they wear their bag on only one shoulder, they might walk tilted to one side and experience neck pain. In addition, if the straps on the bag are too thin, they can dig into the neck and shoulder muscles and potentially cause nerve damage in that area.

How will I know if my child is experiencing back problems?
The biggest warning sign is if she is complaining of back pain. Also, if her posture changes—if she leans forward, backward or to the side once she has her backpack on—that means something's wrong. In addition, excessive redness on pressure points such as her shoulders means the bag is too heavy.

Can these back problems be corrected?
If the problems are caught early enough and your child's habits are changed, back pain can be reduced or eliminated. If you suspect your child is having back problems, take her to her pediatrician to see what therapies or changes might be needed. Carrying heavy loads can cause bigger problems down the road if it's not corrected early.

What should my child do to avoid back pain?
The first thing she should do is have the right kind of backpack. It should have padded shoulder straps, which will distribute the weight of the bag evenly over her shoulders. Also, a bag that comes with a waist belt will help distribute the weight through her hips. The shoulder straps should be adjusted so the bag rests at the middle of the back. If the straps are too tight, it will be difficult to get the bag off, and if it is too loose it will cause your child to lean back too far. A bag with a padded back can also be beneficial in removing some of the pressure. Buying a bag that comes with wheels so you child can roll it is a possibility, although if your child's school has a lot of stairs, it won't help her out much.

Your child should always wear both straps and compartmentalize her belongings so that all the weight in the bag isn't in one place. In addition, she should sort through her bag every night, choosing only what she needs, so she doesn't carry so much. I recommend she make multiple trips to her locker rather than carrying six books around all day. If she has to carry a lot of books, she should keep some in her arms to balance the weight. Ideally, there should be weight equivalent to only 15 percent of her body weight on her back. Weigh her bag on the scale if you need to.

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