Background Musculoskeletal pain is the leading cause of years lived with disability globally. There is evidence of a link between experiences of musculoskeletal pain in childhood and musculoskeletal pain in adulthood. Therefore, it is important to find the factors underlying the onset of musculoskeletal pain in children, who may be at risk of musculoskeletal pain in adulthood. Although research on the risk factors for musculoskeletal pain in adults is extensive, clear information on the risk factors for the onset of musculoskeletal pain in young people is lacking. Our aim was to summarise evidence of risk factors for the onset of musculoskeletal pain in children and adolescents through a systematic literature review.

Methods Five databases (MEDLINE, PsycINFO, AMED, EMBASE, HMIC) were systematically searched from inception to 20 November 2014 to identify studies reporting incident musculoskeletal pain in child and adolescent populations. Studies were included if they were prospective, conducted in the general population, school or primary care settings, and reported on individuals aged 6 to 19 years. Studies were excluded if they had a sample size ≤30 or if the pain was not self-reported by the children (e.g. reported by the parents). There were no restrictions on language or publication date. A best evidence synthesis was applied to the extracted data that considered both study quality and consistency of findings.

Results The electronic search yielded 35,167 references. After title, abstract and full text screening, 43 studies met the eligibility criteria, giving a total population of 38,067 subjects. Twenty-four of the population samples were recruited from school, 19 from the general population, one from hospital and none from primary care settings (one study reported on 2 cohorts of children). Twenty-seven studies were defined as high quality and 16 as medium quality. Strong evidence of association with the onset of musculoskeletal pain was found for: low quality sleep and day-time tiredness with neck pain and for parental pain presence with back pain. Strong evidence of association for high levels of internalising (having emotional problems or being anxious/depressed) and externalising (being aggressive or problematic) behaviour with neck/limb pain was also found. Moderate evidence of association was found between early puberty and back pain, and between headache and neck pain. Low quality sleep and day-time tiredness were associated with musculoskeletal pain only in female subjects.

Conclusion This systematic review broadens the literature on childhood pain and highlights a number of potential risk factors for the onset of musculoskeletal pain.