Objective Unlike in the adult population, back pain is an unusual presenting feature in pre-pubertal children. It should always prompt a detailed history and examination with appropriate investigations to exclude serious underlying pathology. We present 10 cases of paediatric back pain that presented to our emergency department (ED) over a 3 month period from January to March 2008 and go on to discuss the more serious causes of paediatric back pain.

Design A descriptive study of a consecutive series of patients.

Methods Our emergency department is in an urban, tertiary children’s hospital. Patients were retrospectively identified from a review of the hospital database from January to March 2008 using the keyword “back pain”. Cases were examined in detail and followed up to confirm the final diagnosis.

Results 10 cases were identified:

1. Langerhan’s cell histiocytosis

2. Discitis and epidural abscess

3. Sickle cell crisis

4. Discitis

5. Disc prolapse

6. Psychogenic back pain – incidental syrinx seen on MRI

7. Chronic back pain undergoing further investigation

8. Musculoskeletal

9. Musculoskeletal

10. Musculoskeletal

Conclusion Back pain should never be discounted as an incidental or minor finding in children. Our small case series has revealed serious pathology in at least 5 out of 10 patients. Children presenting with back pain require careful evaluation with appropriate investigations and imaging.