Neck pain among pediatric and adolescent patients is quite common. Some theorize this condition is increasing due to changes in how children interface with technology. Unfortunately, there is very little literature published on how to manage this condition. What can we as physical therapists do when there is no literature on how to manage neck pain in children available, let alone any clinical practice guidelines?
While The Neck Pain Clinical Practice Guidelines provides physical therapists with recommendations on best approaches, the guidelines exclude those younger than 18 years of age. So the question becomes, can we still use these? In the absence of other available guidance, the answer is yes. However, we must acknowledge that there are significant and inherent differences between children and adults, particularly in relation to psychosocial factors, as well as biological and developmental differences.
What Psychological Differences Should Be Considered?
The human brain develops rapidly in the first five years of life1 and continues developing well into one’s mid-20s—possibly until the 30s.2 This means that many of the areas activated in a developing brain during a potential pain experience may respond differently than in a fully developed adult brain.
These areas may influence how pain is processed in a child, especially because pain has many factors associated with it, including fear, coping, anxiety, and memory. Pediatric and adult populations deal with pain differently. Children are less likely to process pain cognitively in the way their adult counterparts do, and this means that treatments may need to be adapted to account for these differences.
Furthermore, communication strategies likely need to be adjusted for younger patients. The explanation of pain symptoms should be adjusted to account for such differences in pain interpretation. Even the assessment of pain needs to be considered as most of the tools used to assess for pain and any associated disability are not validated on those younger than 18 years of age.
When explaining the concept of pain to kids, remember that less is more. Kids’ base-level knowledge about pain, and attention span, are limited. Additionally, we want to ensure we are not facilitating fear-avoidance patterns associated with pain.
Here’s one example of how you could discuss pain with a child: “Good news, the ouch you get in your neck is common. There is nothing bad going on. And the other good news is that there are lots of things that we can do to help you, and lots of things that we can give you to help yourself.”
What Role Do Social Differences Play?
Among both children and adult populations, the sole commonality is that pain is directly and indirectly influenced by social interactions. Children have vastly different social structures and exposures. Additionally, these social influences change dramatically from pediatric through adolescent development with different opportunities and pressures.
Managing pediatric and adolescent neck pain often involves parents, and levels of support may vary. Adults and children may struggle to relate to each other. Such dynamics can have a significant impact on recovery from neck pain. While we know that management of musculoskeletal disorders is greatly influenced by therapeutic alliance—and undoubtably should be considered with pediatric and adolescent neck pain—there is no published literature on the topic.
What Is the Importance of Biological Differences?
Biological differences can be greatly influenced by the child’s stage of development. The biology of an older child will have more similarities to that of an adult. The greatest factor that should be accounted for is the susceptibility to rapid periods of growth, especially in the adolescent spine.
Younger populations tend to have more mobility than older populations. They will not demonstrate the same levels of stiffness we may encounter with older patients. However, children tend to have more coordination issues, especially those who are pre-pubescent. This improves significantly as a child gets older. General strength may also be less in a younger population; however, as children approach older adolescents, the relative strength is similar to adults.
How Should We Proceed?
It is essential to understand that children are not small adults. However, children with neck pain may be successfully managed using literature from the adult population, including guidelines; however, PTs must be cautious of the potential biopsychosocial differences, and these should be factored into any plan of care.
Some significant differences also include parental consent, which may be different from what the child prefers. The relationship between parent and child may impact the management strategies and may or may not always align. There is no research on manual therapy and limited expert consensus on what interventions should be provided.
Adding further complexity is that patients under 18 are categorically different depending on the age group (i.e., infant, child, adolescent, late adolescent). The approaches one uses for a late adolescent patient will be similar to an adult population with the exception of consent. The management strategies one uses for prepubescent children will potentially be very different.
To improve your competence and confidence in the management of pediatric and adolescent musculoskeletal neck pain, my course “Treatment of Pediatric and Adolescent Neck Pain” explores the use of treatment-based classifications and clinical practice guidelines, as well as exercises, manual therapies, and education.
- At what age is the brain fully developed? Mental Health Daily. (2015, February 19). Retrieved April 27, 2022, from https://mentalhealthdaily.com/2015/02/18/at-what-age-is-the-brain-fully-developed/
- Brain development. First Things First. (2022, April 26). Retrieved April 27, 2022, from https://www.firstthingsfirst.org/early-childhood-matters/brain-development/