Going to school for the first time is a big day in the life of a child, a day that brings decisive change in many ways, including physical movement.

Children are expected to sit still at school, and the same is true when they do their homework at the end of the school day.

They spend much of their leisure time in front of a screen, moving only when necessary. The constant sitting and lack of movement lead to physical tension and the consequence is often back pain.

In general, children throughout the developed world are moving less and growing increasingly fat. So it is little wonder that the resulting ailments are being felt in their early years.

A major German health insurer has seen back pain in young people rise noticeably over the past 10 years. A study by the Hamburg-based DAK found that youngsters between the ages of 11 and 14 were particularly badly affected.

“Going to school means that movement is neglected,” says Detlef Detjen of the “Healthy Back Campaign” in the state of Lower Saxony.

He believes that every child should play some form of sport, as lack of movement - especially in combination with eating to excess and being overweight - can have unpleasant and lasting consequences for backs and joints, particularly during the years of growth.

Chronic illness can result. “A primary school pupil moves for around an hour a day on average,” says Dieter Breithecker, sports teacher and head of a federal German association to promote good posture and movement.

He advocates four to five hours of movement per day, noting that the period spent by children at unsupervised play has halved over the past two decades, while the number of overweight children has doubled.

Breithecker warns that children are no longer allowed to grow up like children, but are often over-protected.

This is a major issue when it comes to back pain. Children have to play, put themselves to the test and explore their limits. “Parents have to close one eye on occasions,” he advises.

In this way children will begin to find pleasure in movement and this will stay with them their entire life, aside from a brief interruption at puberty, he says. “Parents are aware of the problem, but too little is changing nevertheless,” is the view of Detjen and which is shared by Breithecker.

Parents should lead by example and take exercise themselves, he insists. And they should if possible make their child walk to school or to visit friends.

But in his opinion, parents and doctors are focussing too much on back pain as a symptom. “The child goes to a group where it moves under supervision, but no attention is paid to its true need - to play freely.” Another factor is that children are already under pressure at primary school, with social pressure to achieve as good school results as possible to succeed in later life.

Primary school results determine whether a youngster goes on to an academic stream or not, and this psychological pressure can also lead to back pain, in the view of both Detjen and Breithecker.

When it comes to school satchels, their opinions diverge.

Breithecker believes the fuss over them is unjustified. “Children wear their satchels for five or 10 minutes at most, and not even a heavy satchel can cause much damage in this short time,” Breithecker believes.

A school satchel should weigh no more that 1.3 kilograms. When full it should not exceed 15 per cent of the child’s body weight. The straps should be at least four centimetres wide and well padded to distribute the weight, with the side against the back formed ergonomically to reduce the load on the spine. Heavy objects, such as books, should be placed close to the back.

Detjen says that a badly designed satchel can result in poor weight distribution and ultimately in back pain.

He also says the back should be considered when designing a child’s work-station. The chair height should be adjustable without difficulty and the seat should move, so that the child can rock backwards and forwards.

The chair is at the correct height when the soles of both feet can reach the floor, and the height of the desk should be adjustable to accommodate the child’s growth. The height is right when the child’s elbows are a couple of centimetres below desk level when the arms are hanging down and the child is sitting upright.

The desk surface should be at an incline of at least 16 degrees to provide for an ergonomic head position.

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