A Teenage Girl with Acute Back Pain

Initially, when presented with a child with back pain, it is important to consider a broad and complete differential diagnosis because back pain in children is often the sign of a pathological process. The red flags to be aware of when evaluating a child with back pain are acute or progressive back pain, limitation of activity, any neurologic signs or symptoms, and pain unresponsive to anti-inflammatory drugs. Malignancy is an important consideration in children with back pain, and evidence of at least 2 abnormal cell lines on a complete blood count requires evaluation for an oncologic process. Although rare, back pain may be the initial and only manifestation of leukemia.