Heavy school bags cause children's back pain

What the research found

A 2018 systematic review looked at 69 studies of more than 72,000 children and teens. Most were cross-sectional snapshots. In the five studies that followed children over time, bag weight, design and how the bag was carried did not increase the risk of developing back pain.

Older and smaller studies point the other way. A 2003 review linked bags over 15% to 20% of a child's weight with back pain. A 2021 review of 14 observational studies reported backpack-related back, neck and shoulder pain in teens. A 2015 Irish study of 529 primary school children looked at discomfort after carrying bags.

Lab studies show how loads affect the body. In a 2008 trial of ten children, heavier and lower-slung packs put more pressure on the shoulders. A 2002 trial of 250 adolescents found loads changed standing posture. Neither shows that this leads to ongoing back pain. The 2003 review found no evidence that backpacks cause structural spinal deformity.

What it doesn’t mean

• This does not mean bag weight is irrelevant. A bag can make a child's back, neck or shoulders sore on the day, and guidance still recommends light, well-packed bags worn on both shoulders.
• Back pain in children has many possible causes, including poor posture, lack of exercise, injuries from sport and some medical conditions. Blaming the school bag alone may miss the real cause.
• See a doctor if your child has ongoing back pain, or pain that wakes them at night or comes with long morning stiffness.