Back problems are usually associated with the ails of advancing age. So it may surprise you to learn that studies performed during the past decade have unearthed near epidemic levels of back pain in school children—in some major studies, nearly 50 percent of school-age children reported having lower back pain.

So what’s causing normally sprite, rubber-like children to suffer from daily pain? Signs point to that irreplaceable locus of school books, assignments, and supplies. It's the center of a child’s school life: the backpack. Studies show that children who regularly use backpacks are more likely to report back pain, that heavier backpacks unquestionably caused more pain, and that when children put their backpacks away, their back pain goes away too.

Is the Backpack to Blame?

Backpacks themselves probably don’t deserve a bad reputation. Compared to the alternative options—shoulder bags, messenger bags, or purses—a backpack is actually the healthiest way to carry a heavy load of books. A backpack is designed to distribute the weight of the load across the strongest muscles in the human body—the back and abdominal muscles.

Because of this design, backpacks will almost never cause serious or long-term back pain. “There are no studies that show spine pathologies are caused by backpacks,” says Abigail Allen, director of the Pediatric Orthopaedic Clinic at the Mount Sinai School of Medicine in New York. Dr. Allen is intimate with spinal issues in children. Most of the time, says Dr. Allen, back pain in children is muscular pain from overuse and is manageable. Nevertheless, “you should never ignore back pain in a child—especially young children,” warns Dr. Allen.

Muscle pain caused by backpacks usually occurs because children don’t wear their backpacks correctly or load them with far too much weight. Luckily, it just takes a little common sense and some moderation to prevent backpack-related back pain. Here are some things to consider when buying and using a backpack that can save you trouble down the road.

Purchasing a Healthy Backpack

Consider these features when purchasing a backpack to ensure you get one that keeps your child feeling great.

  • Lightweight. Choose a backpack made of canvas or nylon so there isn’t any extraneous weight to carry around.
  • Multiple compartments. Besides keeping your child organized, multiple compartments can help to distribute the weight of books and supplies more evenly throughout the bag.
  • Padded straps. Make sure your pack has two fairly wide, padded shoulder straps to distribute the weight of the pack evenly. Narrow straps can dig into the shoulder.
  • Padded back. A pack with built-in padding in the back panel can help take some pressure off your child’s back.
  • Waist belt/hip strap. A waist belt can take some of the weight of the pack off your child’s back and onto his or her hips instead.
  • General comfort. This may be obvious, but make sure your child is comfortable wearing the pack. There shouldn’t be anything that sticks out of the bag and pokes your child, and it should feel comfortable on his or her back. Also make sure your child is confident and happy to use the backpack—involve them in the decision to ensure you don’t buy something too "uncool."

Obviously, a backpack that rolls on wheels (like a small piece of airplane carry-on luggage) can help your child avoid back pain. However, rolling backpacks come with their own set of problems and inconveniences. They may not fit in school lockers; they may be difficult to maneuver; and in areas of the country with inclement weather, they may be impractical (imagine dragging a wheeled bag through the snow).

Also, don’t be fooled by fancy brand names or “features.” According to Dr. Allen, a $20 bag is just as likely to be healthy for your child’s back as an $80 version loaded with extras.

Wearing a Backpack Safely

Here are some tips on how to lessen the physical impact of having to wear a backpack day after day.

Lighten the Load

Twenty pounds may not seem that much, but for a kid who weighs only 75 pounds, that’s nearly a third of their body weight! Imagine if you had to carry around a 55-pound weight on your back all day. The American Academy of Orthopedic Surgeons recommends that children should carry no more than 10 percent of their body weight in their backpacks. To lighten the load, make sure that your child is only carrying the books he or she needs between classes and for studying at home. Encourage leaving as much as possible in the locker. “Not all books have to go in the backpack,” suggests Dr. Allen. “You can put half in the pack and carry the rest in your arms.”

Two Straps

Make sure your child isn’t slinging the bag over one shoulder. Backpacks are built with two straps for a purpose—to distribute the weight of the load across the entire back.

Get the Right Fit

Tighten the straps so that the backpack rests snug against the body and sits approximately two inches above your child’s waist. If there’s a waist belt, tighten it across your child’s body. Make sure all straps are also snug, but not too tight.


Try to distribute weight evenly among the compartments in the bag, and make sure that there isn’t an inordinate amount of weight being piled onto the top of the bag.

Final Word

Wearing a backpack properly is important, but Dr. Allen helps put it in perspective. “If worn and used properly, kids are more likely to trip over a backpack and have a wrist injury than have back pain.” A study from a few years back found that 98% of emergency room visits related to backpacks had nothing to do with the back. They were usually related to things like children hitting other children with their backpack or someone tripping over a stray bag left in a hallway. The bottom line: While you should definitely watch how your child wears his or her trusty backpack this school year, there’s definitely no reason to throw it out.