Table 1:

Symptoms and signs that may indicate serious underlying pathology in children with back pain—red flags

History	Examination
Prepubertal children especially <5 years	Fever, tachycardia
Functional disability	Weight loss, bruising, lymphadenopathy, or abdominal mass
Duration >4 weeks	Altered spine shape or mobility
Recurrent or worsening pain	Vertebral or intervertebral tenderness
Early morning stiffness and/or gelling	Limp or altered gait
Night pain	Neurologic symptoms
Fever, weight loss, malaise	Bladder or bowel dysfunction
Postural changes: kyphosis or scoliosis
Limp or altered gait

Reproduced with permission from BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.¹⁵