TY - JOUR T1 - Highlights from the literature JF - Archives of Disease in Childhood JO - Arch Dis Child SP - 624 LP - 624 DO - 10.1136/archdischild-2022-324347 VL - 107 IS - 6 A2 - , Y1 - 2022/06/01 UR - http://adc.bmj.com/content/107/6/624.abstract N2 - How do you approach a child or young adult with lower back pain (LBP)? Lucina has always found this a challenge with the desire to reduce unnecessary imaging and investigations but the worry about missing serious pathology. The causes of back pain in children are different compared with adults. Pate JW et al (J Paediatr and Child Health 2022; 58:566–71. doi:10.1111/jpc.15933) have presented a really useful approach to the assessment of LBP and it is well worth a visit. They highlight unique pathologies that only occur in this age group: (i) serious pathologies include infection, fracture, child abuse and malignancy; (ii) growth-related pathologies include scoliosis, Scheuermann’s dis- ease, pars fracture and spondylolysis; and (iii) rheumatological conditions include juvenile idiopathic arthritis and ankylosing spondylitis. They present a systematic and practical approach, emphasising a child and adolescent perspective. Lucina particularly liked their advice regarding the structure to physical examination: (i) observation (static and dynamic); (ii) active range of motion; (iii) passive range of motion; (iv) isometric muscle testing; (v) manual muscle testing; (vi) passive accessory movement testing also called ‘Joint Play’; (vii) neurological screening; (viii) special tests; (ix) functional tests; and (x) palpation. It’s a great review.Inactivated influenza vaccines (IIV4) are the most commonly administered influenza … ER -