The issue of school bag is a favorite topic of the media during the past years at the start of each school season. Unfortunately, confusion and concern is created among parents with no one giving them a clear answer as to which is the appropriate school bag and what is its maximum weight, to avoid causing health problems to the child.

The problem concerns western societies for years. There have been many researches by doctors, physiotherapists, ergonomists and conclusions were reached. The important conclusion, however, of all these studies, is that common sense should prevail.

The key question is the following: can the weight of the school bag create anatomical abnormality in the developing child's skeleton and especially the spine?

The answer is clearly NO. It is surprising even how the myth that heavy school bag hanging on one side creates scoliosis was maintained. We know that scoliosis is a disease of the developing spine generated from endogenous organic factors and cannot be prevented by special exercises and gymnastics, or special school bags. If it was that simple, children would hang their school bags from the other side and in such a way straighten their backs. It has also been shown that children who have scoliosis do not get worse by heavy school bags. Also the weight of the bag has nothing to do with whether the child will develop hyperkyphosis, i.e. hump. The forces, that the spine receives while carrying the school bag, are not capable to alter bone growth because of the short duration they are exerted.

But surely the weight of the school bag is associated with the occurrence of pain in the waist and back of the child. This is the main reason of concern for parents.

The issue became a problem in USA when it was decided to abolish school lockers of high school students. This was done for safety reasons in order to prevent vandalism. So, the students had to carry their books and personal belongings for longer during the day and started complaining about pains. As a result, researches began to prove the obvious.

In the largest, well-designed research, involving 3.457 children, from 11 to 15 years old, it was found that 64% of them felt back pain. 41% felt this pain when carrying a school bag while the pain left when they removed the bag. 16% of the children said they had lost school hours or gymnastics or extracurricular sports activities in order to visit a doctor because of the pain. They studied all factors related to the school bag and the likelihood of pain (the weight of the bag in proportion to body weight, the mode of the bag carrying: on one hand, with both hands on one shoulder, on both shoulders, if they go away to school or not).

The results of the statistical analysis showed that the higher probability for a child to complain of pain in the back was if it were a girl, and had to carry a fairly heavy bag. No other factor was related to the occurrence of pain. Unfortunately, the researchers were unable to establish a safe weight for a school bag. If the weight of the bag is 5% of the body weight, the probability of the child carrying it to complain is 37%, whereas if the weight is 20% of the child's body weight, the probability is 52 %.

Useful tips for parents and teachers

Common sense, therefore, says that we should try to reduce the weight of school bags to minimum necessary. We do not want to hurt children.

The school officials must ensure that they have lockers in every classroom for every student so that they are not forced to carry materials and books not in need at home. Today we live in the electronic age and we have the ability to transfer entire books in small memory sticks and light laptops.

Parents should ask their children if they have difficulty or pain when carrying their school bag because of its weight. They should not exaggerate about nor ignore the pain in the waist and back. If the problem cannot be solved by changing the weight of the bag, parents have to consult an orthopedic specialist.

It takes great attention not to turn a simple problem of physical fatigue to a major medical issue that will mainly concern sensitive teens. There is evidence that adolescents who experience back pain continue to have problems in adulthood. And it is not clear whether this is due to organic or psychosomatic causes.

Written by Kollintzas Lykourgos MD
Orthopaedic Surgeon