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Table 1: 
Symptoms and signs that may indicate serious underlying pathology in children with back pain—red flags
HistoryExamination
Prepubertal children especially <5 yearsFever, tachycardia
Functional disabilityWeight loss, bruising, lymphadenopathy, or abdominal mass
Duration >4 weeksAltered spine shape or mobility
Recurrent or worsening painVertebral or intervertebral tenderness
Early morning stiffness and/or gellingLimp or altered gait
Night painNeurologic symptoms
Fever, weight loss, malaiseBladder 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