School Backpacking Could Send Thousands of Children to the Hospital

HOUSTON (Aug. 31, 2010) – With more than 10,000 annual visits nationwide to doctors or emergency centers by school-aged children suffering from neck, shoulder and back pain because of misuse or overloading of school backpacks, the Harris County Hospital District offers some simple recommendations to help children avoid these preventable injuries.  

Incidence of pediatric neck, shoulder and back pain is approaching rates seen in adults. About 24 percent of back pain related emergency room visits by adolescents are due to lumbar related muscle strains. Physical therapists at Quentin Mease Community Hospital, the Harris County Hospital District’s dedicated physical medicine and rehabilitation facility, report that early back pain problems in children are often predictors of future back health concerns as adults.  

“With more than 40 million American students carrying back packs in school, it’s no wonder that this is a major concern for parents, teachers, school administrators and healthcare professionals,” says Marcus Cantu, PT, DPT, physical therapist, Quentin Mease Hospital.   

A 2001 study found that one-third of all high school students don’t use their lockers, which means they carry their books with them all day. Some schools have gotten rid of lockers altogether. When used correctly backpacks are a popular and practical way for students to carry their books and supplies during the school day. When used incorrectly they can cause injuries to muscles and joints that can lead to severe back, neck and shoulder pain, as well as alterations in posture and body mechanics.   

Physical therapist Dana Tew, PT, MS, Quentin Mease Hospital, says backpack education consists of three areas: recognition when a backpack is too heavy; identification of desirable backpack features; and instructions in the proper way to pack and wear a backpack.   

Backpack too heavy?
Backpack weight should not exceed 10-15 percent of a child’s total body weight. Yet most experts cannot agree on what is considered the maximum safe backpack weight for children to carry and the percent body weight calculation does not take into account a child’s height, body fat or overall muscle strength.   

Five warning signs that a backpack is too heavy:

  • Struggling to put on or take off the backpack
  • Pain when wearing the backpack
  • Tingling or numbness in the shoulders, arms or hands
  • Red marks left on shoulders by shoulder straps
  • Noticeable changes in posture  

Choosing backpack features
Desirable backpack features include:

  • A backpack should match the length of the child’s torso. The pack should not be larger than the child’s back. For a proper fit, measure the back width from one shoulder to the other, then measure the length of the back from shoulder line to waist line and add 2 inches.
  • A padded back is recommended to reduce pressure and to enhance comfort so that contents do not put added pressure on the child’s back.
  • Two contoured and wide padded shoulder straps are recommended to reduce pressure on the torso and shoulders by equally distributing weight.
  • Use hip and chest belts when the load is heavy, to transfer weight from the back and shoulders to the hips and torso.
  • Choose a backpack with multiple compartments so weight can be distributed equally and items are easier to find. 

Wearing and packing it properly
The American Physical Therapy Association and American Academy of Orthopedic Surgeons recommend these weight limits: A 60-pound child should carry a maximum of 5 pounds; 60- to 75-pound child, 10 pounds; 100-pound child, 15 pounds; 125-pound child, 18 pounds. In general a loaded backpack should weigh no more than 10-15 percent of a child’s total body weight   

Other items to consider when carrying and packing a backpack are:

  • Pack heavier items at the bottom or closer to the back.
  • Pack flat items where they will rest on the back, with bulky items away from the back.
  • Use both shoulder straps.
  • Tighten the shoulder straps so the backpack hangs slightly below the shoulders with no more than four inches hanging below the waist line.
  • Use the waist and chest straps.
  • Consider using separate lighter packs for separate activities.

The Harris County Hospital District recommends parents obtain a referral to see a physical therapist from their physician when back, neck or shoulder pain are disruptive to a child’s daily school or home life.



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