Musculoskeletal Complaints Among 11-Year-Old Children and Associated Factors

The PIAMA Birth Cohort Study

Gerben Hulsegge; Sandra H. van Oostrom; H. Susan J. Picavet; Jos W. R. Twisk; Dirkje S. Postma; Marjan Kerkhof; Henriëtte A. Smit; Alet H. Wijga


Am J Epidemiol. 2011;174(8):877-884. 

In This Article

Abstract and Introduction


Musculoskeletal complaints (MSC) are common among children, often persist into adolescence, and increase the risk of MSC in adulthood. Knowledge regarding determinants of MSC among children is limited. The aim of this study was to determine the prevalence of MSC at age 11 years and to examine associations with sociodemographic factors, growth and development factors, mental health, tiredness, and lifestyle. Data from a Netherlands birth cohort study, the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) Study (n = 2,638), were used (1996–2009). MSC were defined as complaints about the back, an upper extremity, a lower extremity, or any of these sites. Logistic regression analyses using a forward stepwise procedure were performed on multiply imputed data. The 1-year period prevalences of back, upper extremity, and lower extremity complaints that lasted at least 1 month were 2.8%, 4.8%, and 10.9%, respectively. Only poorer mental health was consistently associated with all 3 types of complaints. Poorer mental health, daytime tiredness, early pubertal development, being physically active at age 11 years, and weight-for-height z score were associated with having any MSC. This study showed that MSC, especially lower extremity complaints, are common among 11-year old-children and that only poorer mental health status is associated with MSC at all anatomic sites.


Musculoskeletal complaints (MSC) are common in children, with prevalences up to 32% being reported for children aged 10–12 years.[1] This may have a large health impact, since pain can result in restrictions in daily living activities, including school attendance, participation in hobbies, maintenance of social contacts, and sleep problems.[2] Additionally, it has been suggested that approximately 40% of children with MSC still have complaints 4 years later[3] and that MSC in childhood substantially increases the risk of MSC in adulthood[4–6] which is a major public health problem with a high economic burden[7,8] A better understanding of the determinants of MSC in childhood may help in developing preventative strategies for children.

Low socioeconomic status, being overweight, physical activity, a sedentary lifestyle, and mental health problems have been suggested as risk factors for MSC among children or adolescents. However, until now the number of studies has been limited and the results have been inconsistent[9,10] For instance, some studies showed that physical activity is associated with increased MSC among children or adolescents,[11,12] while other studies found a protective association[13] or no association[14,15] In addition, most evidence pertains to adolescents aged 12–16 years. Studies in children below age 11 years have not investigated the role of possible risk factors such as socioeconomic status, ethnicity, pubertal status, and changes in weight, height, and physical activity over time. Furthermore, most previous research in youth has focused on back pain and, to a lesser extent, on neck pain, shoulder pain, and specific MSC. However, MSC regarding all body parts are common,[1,9,14] even among children.[1] Therefore, additional research is needed, including research on MSC at different anatomic sites and a variety of possible risk factors for MSC, for a better understanding of the occurrence of MSC in children.

Our objective in this study was to determine the prevalence of MSC at age 11 years in a birth cohort study (the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) Study) and to examine which factors are associated with MSC at age 11. We studied back complaints, upper extremity complaints, and lower extremity complaints and their associations with several sociodemographic factors, growth and development factors, psychosocial factors, and lifestyle.


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