In the past, back pain was considered to be uncommon problem among children and adolescents, however, recent reports suggest that back pain is relatively common in this age group. Approximately 50% of kids and teenagers experience back pain at some point, up to 10% of them may have it severe enough to keep them out of school or sports. Although most back pain is generally not due to an underlying serious problem, this is not always the case, conditions like tumors, infections, deformities, spondylolysis or trauma should be always rolled out, as a matter of fact, some spine diseases may worsen severely in absence of back pain as a clinical presentation. Parents and spine practitioner should always have a high index of suspicion to rolled out the presence of red flags in the kids’ clinical presentation.