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By Dr. Gregory Gordon
Pediatric Associates of Orlando

Back to school means backpacks. Parents often worry about the weight of their child’s backpack and potential back problems. In 1999, the Consumer Product Safety Commission reported more that 8,500 school aged children (5 to 18 years old) sought medical care for backpack-related injuries. That same year a survey of Orthopedic surgeons found that 58% of them had treated a pediatric patient for back or shoulder pain caused by backpack use.

Unfortunately, trusted medical groups do not currently have guidelines on children and backpacks. Neither the American Academy of Pediatrics, the American Academy of Orthopedic surgeons nor the Pediatric Society of North America have a current policy in place to help parents with these concerns.


Backpacks… tips and safety for back to school

As I began to dig into the medical research surrounding backpacks, children and back problems, I began to understand why there were no clear guidelines. The research itself is unclear and rare. Much of the research focuses on the search for clear guidelines, but most of it was limited or inconclusive.

What do we know?

  1. Children who carried the heaviest backpacks were 50% more likely to develop back pain.
  2. Teenage girls have the highest number of complaints of back and shoulder pain.
  3. There is no link between scoliosis and backpacks.

Several studies investigated proposed guidelines for backpacks based on the child’s weight. These recommendations are often based on the relative weight of the backpack compared to the child – most often stating that their backpack should not weigh more than 10% of the child’s weight. This means that a 100 pound child should not carry a backpack weighing more than 10 pounds. Unfortunately, some authors recommend 15%, 20% or even 25% as an upper limit. Several authors even question the safety of a 10% load.

Students often carry backpacks beyond the proposed 10% rule. Several studies conclude that only 40% of students carried backpacks at or below 10% of their weight. Younger students seem to suffer with relatively heavier loads. Another study found that young students in particular exceed these weight-based guidelines. This study found that 78% of grade one, 43% grade two and 40% of grade three students carried backpacks beyond the 10% weight rule.

It is interesting to note that while younger children do seem to carry relatively heavier loads, teenagers have the highest rate of back pain complaints. There must be additional risk factors other than simply the weight or relative weight of a child’s backpack.

Tips to avoid backpack problems:

  1. Purchase a backpack with padding.
  2. Choose a backpack with wide, padded straps and belt support.
  3. When choosing a backpack, consider the actual weight of the backpack.
  4. Pack the heaviest material closest to the front.
  5. Use both shoulder straps.
  6. Make use of lockers or classroom sets of books.
  7. Exercise. Children (like adults) need to exercise to help avoid injuries.

Experts often recommend backpacks with wheels to avoid back issues. Before purchasing one, please ask your school if they allow rolling backpacks. Many schools in our area have rules prohibiting rolling backpacks.

I don’t think we will ever have clear backpack guidelines for children. We definitely need more definitive research, and research takes time. Each year an increasing number of schools are transitioning to iPads or laptops over traditional text books. As such, backpacks are getting lighter. Hopefully, that will translate into fewer children suffering from back pain.


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