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Children's Backpack Safety for Future Health
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While back pain has long been one of the most common complaints among adults, evidence is mounting that back pain among children is increasing and that using overloaded or incorrectly worn backpacks is a primary cause.
In 2001 more than 7,000 emergency room visits were related to backpacks and book bags with about half of those injuries occurring in children from 5 to 14 years old, according to the American Occupational Therapy Association, Inc. (AOTA). Another U.S. study reveals that 6 out of 10 students ages 9 to 20 reported chronic back pain related to heavy backpacks, while among students who carried backpacks weighing no more than 15 percent of their body weight only 2 out of 10 reported chronic back pain. The good news, according to AOTA, is that a study of children exposed to backpack education revealed that nearly 8 out of 10 middle-school students who changed how they loaded and wore their backpacks reported less pain and strain in their backs, necks and shoulders.
Warning Signs
"Disproportionate weight and improper use of backpacks may cause back pain in children that can extend into adult life," says Patty Haggen, PT, MHA, director of Rehabilitation Services and a physical therapist at John Muir Health. "Children compensate for heavy loads by assuming unnatural postures such as leaning forward orarching the back. In wearing only one shoulder strap a child leans to one side and distorts his/her posture. It's important for parents to pay particular attention to their children's posture as they wear backpacks."
Haggen adds that in addition to posture changes other warning signs of potential back problems include:
- Pain when wearing backpacks
- Tingling or numbness in children's arms
- Red marks on children's shoulders
- Children struggling when taking the backpack off or putting it on
Backpack Guidelines
Concerning general guidelines for backpack use, Haggen underscores the recommendations of the American Physical Therapy Association (APTA):
Wear Both Shoulder Straps: This distributes weight better and aligns spinal posture. It is also recommended to purchase a backpack with extra wide and padded shoulder straps. Shoulder straps should be adjusted so that the pack fits snugly to the child's back. Loosely hanging backpacks strain muscles by pulling the child backward.
Lighten the Load: Backpacks should never weigh more than 15 percent of children's body weight. (That would only be 11 pounds for a child weighing 75 pounds.) The average student carries a backpack weighing almost one fourth of body weight. Typically 3 out of 10 students carry backpacks weighing up to one third of body weight at least once a week— that's twice the recommended weight.
Carry Essentials for the Day Only: Heavier items should be loaded first, making them closer to the body. A backpack with compartments is best as it allows for more even distribution of weight. If the essentials weigh more than 15 percent of body weight, the child can hand carry books.
Should Rest in Middle of Back: This allows for more even distribution of weight and creates far less strain than if the backpack were to sag lower. The bottom of the pack should rest in the curve of the lower back and should never rest more than four inches below the child's waistline. Positioning the backpack at approximately the body's center of gravity has the least effect on posture.
Both Chest and Waist Straps Best: Backpacks with this feature allow for more balanced distribution of weight and reduce any possible strain.
Ease of Use: It is important that whatever kind of backpack is chosen, it should be easy to use—putting it on or taking it off.
Haggen says parents should consider using a backpack on wheels for young children who don't have to go from room to room or floor to floor during the school day. These bags would not be very functional for older children who move from place to place during the day, she says. If the backpack on wheels option is chosen, it is important that the extended handle be long enough so the child will not have to twist and turn when pulling it.
The importance of backpack education presents an opportunity to teach proper fit and use to reduce the risk of back pain in children. Early education is the key to prevent problems later on in life.
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