How do you know when a child is making up pain to get out of something or really hurting? Our 12 year-old son hasn’t been doing well on his soccer team. Now he’s suddenly developed back pain. He says he got kicked in the back in the last game but no one saw it happen. We think maybe he just doesn’t want to go back. What should we do?

Back pain (in adults) is so common, eight out of 10 people will experience it at least once (and often more than once) in their lifetime. Most of the time, no one even knows what’s causing it — the condition is said to be idiopathic. It’s nothing serious and treatment isn’t even needed. The patient is told to stay as active as possible. Recovery occurs in seven to 10 days. But back pain in children is something else altogether.

Idiopathic back pain in children and especially in young athletes is much less common. There is usually a very specific reason for the pain. It could be an infection, tumor, or inflammatory condition. More often, it’s an injury from a traumatic event or from repetitive motion causing microtrauma.

All reports of back pain in children and teenagers should be taken seriously until proven otherwise. A medical examination is usually the best way to find out what’s going on. An early, accurate diagnosis and treatment without delay is often needed to prevent a minor back injury from becoming a major problem.

If a musculoskeletal problem is ruled out, then it might be time to look for social and psychologic reasons for avoiding sports activities.