The weight of the world seems to be on children's shoulders these days, and it is leaving an impact on their backs. Sounds unlikely? In today's society, it isn't just the office-inflicted or age-inflicted that complain of an aching back.

Back pain and back conditions are common reasons for visiting the orthopaedic clinic at KK Women's and Children's Hospital, said consultant Kevin Lim.

'The clinic sees about 15 to 20 new cases of back pain a week. Many more attend to evaluate spine alignment,' he said.

Neck, back and shoulder pain can all result from bad posture or bad habits, and lugging huge bags to school is one of the biggest causes.

'(They) cause great concern and anxiety for parents,' Dr Lim said.

In 1999, a study of 140 secondary school students in New Zealand found that 77 per cent had either neck, shoulder, upper back or lower back pain.

A large-scale study in 2002 found that children who carried weights more than 10 per cent their body weight had more back pain.

The study of 1,000 children was carried out in Delaware in the United States by a children's hospital.

In Singapore, a typical Primary 3 pupil weighs about 30kg, but carries backpacks some 27 per cent of his body weight, said Dr Matt Kan Wai Ming, director of the Chiropractic First group of clinics.

For Wong Keng Mun, now 12, his backpack, when he was in Primary 1 and 2, was so heavy that he had to ask his mum to help him remove it.

Payroll executive Wong Choi Fung, 46, said: 'He complained of backache after school, and his posture was bad when sitting or walking.'

She bought him a trolley-style bag, and though his school objected at first, due to it getting in the way in corridors, it relented.

This is a weighty concern in Singapore, with discussions going up to the government level.

On March 8 last year, MP Chan Soo Sen commented on the school bag problem in a committee meeting. 'With proper planning, students need to bring only whatever they need. Schools also provide lockers for students to store their belongings,' he said.

'Having said this, if parents find that their children's school bags are still too heavy, they are encouraged to go through it with their children so that they bring only what is necessary.'

Schools like Casuarina Primary School have allowed their students until Primary 6 to use trolley bags, said Ms Norsham Mohammed, who is a health education coordinator there.

'We also do spot checks on the children twice or thrice a month, to assess if they have back pain,' she said.

But bags are not the only culprits. There is the rough and tumble of childhood to contend with too.

'Research says that by the age of 12, a child would have had over 2,000 slips and falls,' said Dr Kan.

Dr Lim added that while children will take spills, 'it is not necessary to have them checked for spine injuries after every fall'.

'A check-up is needed if the child complains of persistent back pain,' he said.

Signs and symptoms of back problems could be pain, swelling, numbness, headaches and fatigue.

The Delaware study also found that children who were overweight and led inactive lifestyles were more prone to back discomfort.

Spurred on by the increasing number of parents bringing their children in for treatment, Dr Kan started a Children Spinal Re-adjustment programme.

Part of treating children in this programme is educating parents on how to encourage good back habits.

This means tackling the school bag issue, how they sit at the computer, and how they study.

Nine-year-old Alicia Goh's back problems came from the way she sits and holds herself, her mother, Madam Veronica Ghong, believes.

The 41-year-old housewife says her daughter did complain about pain, but she did not know what to do about it. A friend recommended chiropractic treatment to her.

There are three types of back injury: high impact, high force, which includes slips, falls or sports injuries; low impact, high force, which includes injuries while pushing, pulling, or carrying loads; and repetitive bad posture, which includes sitting on a chair that is the wrong size, or sitting hunched over a keyboard, for example.

Chiropractors claim that manipulation and re-alignment of misplaced vertebrae can help lessen the pain.

Besides taking their children to a chiropractor or orthopaedic clinic for treatment for back problems, there are measures parents can implement at home and school.

Said Dr Lim: 'In most instances, back pain is a result of poor posture, or unaccustomed exercise or over-exertion.

'Serious causes for back pain in children are fortunately quite rare.'

E-mail: elainey@sph.com.sg

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Treatment not painful

During his chiropractic treatment, 11-year-old Jonathan Lim (above, with chiropractor Matt Kan) is quick to say. 'It is not painful.'

Jonathan's mum, Madam Miriam Ng, 46, made his first appointment in April this year, after a friend's recommendation.

She says: 'He was putting on his swimming trunks and I saw how his spine curved. Very clearly.'

Not only does Jonathan regularly slip over his own feet and fall but he will sit in the same position for hours at a time while studying.

Says his homemaker mum: 'His PSLE is this year so he has a lot of homework. Because he will have to sit for almost three hours in the exam, he trains at home.'

And his bag is very heavy. Jonathan weighs 36kg while his bag weighs 5.5kg. No wonder Jonathan had a pain in his neck or shoulder.

Now he takes a trolley bag to school.

Once Jonathan's session is done, it is Justin's turn.

Justin Lo is 10 years old, and a sports injury has left him limping. He plays rugby and soccer and is forever falling or getting sports-related knocks.

His mum, Madam Joanna Tan, says she was not concerned at first.

The 47-year-old secretary says: 'He would ask me to massage his back but when I pressed down on it, it was painful. I thought it was just a muscle sprain.'

The pain got worse and worse and when mum's touch became unbearable to take, she sought treatment.

However painful his injuries are, he isn't giving up either sport.