Children and Adolescents

 
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VII.0

Lead Author(s): 

Scott B. Rosenfeld, MD
Aimee O. Hersh, MD

Supporting Author(s): 

Ellen M. Raney, MD
Sylvia Watkins-Castillo, PhD

Previous sections in this text clearly demonstrate the large percentage of health care visits that are attributable to musculoskeletal conditions. Most of the data used to establish these estimates concern adult patients. Unfortunately, there is significantly less information regarding the burden of these conditions in young patients.

Studies, however, do support that pediatric musculoskeletal conditions similarly account for a significant portion of visits to medical providers. For instance, de Inocencio reported that greater than 6% of total visits to pediatric clinics were for musculoskeletal pain.1 Schwend reported that approximately one third of pediatric medical problems are related to the musculoskeletal system.2  In a population-based study in Ontario, Gunz reported that 1 in 10 children made a health care visit for a musculoskeletal problem and that 13.5% of all visits for musculoskeletal disease were made by patient’s age 0 to 19 years.3 Four in 1,000 children are reported by parents as having difficulty with activities of daily living due to musculoskeletal conditions. A search of the National Health Interview Survey (NHIS) child sample revealed that musculoskeletal conditions accounted for 10.9% of parent-reported health conditions for children and adolescents age 0 to 17 years in the US in 2012. This proportion was greatest at 22.6% in the 13- to 17-year-old age group. (Reference Table 7.0 PDF CSV)

Parent-Reported Musculoskeletal (MSK) Conditions for Children and Adolescents Age 6 to 17, by Age, United States 2012

The evaluation and treatment of these pediatric musculoskeletal conditions resulted in approximately 149 million missed school days in 2012. Musculoskeletal conditions are surpassed only by respiratory infections as a cause of missed school days.  Joint pain was the most frequent cause of missed school days, closely followed by low back pain. Missed school days due to musculoskeletal pain was higher for adolescents in the junior- and senior-high age range than for children of grammar-school age. (Reference Table 7.0.1 PDF CSV)

Parent-Reported Missed School Days Due to Health Conditions for School Age Children and Adolescents, by Age, United States 2012

Parent-Reported Missed School Days Due to Musculoskeletal Conditions for School Age Children and Adolescents, by Age, United States 2012

The indirect burden of pediatric musculoskeletal disorders is amplified by the effect on the family and caregivers. Each time a child visits a care provider for evaluation or treatment results in missed workdays and wages by parents and caregivers. Additionally, the emotional impact that many chronic musculoskeletal conditions have on the family is immeasurable. Furthermore, as compared to adult conditions, pediatric musculoskeletal conditions may have lifelong ramifications resulting in compounding burdens over time. (Reference Table 7.0.2 PDF CSV)

Parent-Reported Limitations in Activities of Daily Living (ADL) for Children and Adolescents Under Age 18 Due to Select Medical Conditions, United States 2012

Despite the significant contribution made by musculoskeletal conditions in the total US health care burden, research for pediatric musculoskeletal conditions is grossly underfunded. Of the $3.25 billion in National Institutes of Health (NIH) research funding for all pediatric conditions in 2013, only $46.8 million, or 1.4% of total pediatric medical research funding, went toward pediatric musculoskeletal research. Even under the umbrella of funding specifically for musculoskeletal research, pediatric-specific research is under-represented. Of the $424.4 million in funding for the National Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS) in 2013, this same $46.8 million represented only 11% of total musculoskeletal research dollars.4

Pediatric Condition Research Funding Dollars, United States 2013

  • 1. de Inocencio J: Musculoskeletal pain in primary pediatric care: Analysis of 1000 consecutive general pediatric clinic visits. Pediatrics 1998 Dec;102(6):E63.
  • 2. Schwend RM, Geiger J: Outpatient pediatric orthopedics: Common and important conditions. Pediatric Clinics 1998 Aug;45(4):943-971.
  • 3. Gunz AC, Canizares M, Mackay C, Badley EM: Magnitude of impact and healthcare use for musculoskeletal disorders in the pediatric: A population-based study. BMC Musculoskeletal Disorders 2012;13:98.
  • 4. U.S. Department of Health and Human Services, National Institutes of Health (NIH) Research Portfolio Online Reporting Tools (RePORT). http://report.nih.gov/fundingfacts/fundingfacts.aspx  Accessed January 5, 2015.

Edition: 

  • 2014

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