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Detectives in the Classroom

Ancillary Materials for Lesson 1-2

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1. Go To – Five Part 1 backpack / back pain articles

2. Go To – Seven Part 2 backpack / back pain articles
3. Go To – Epi Log Worksheet
4. Go To – Presentation Rubric
1. Copy the five Part 1 backpack / back pain articles and assign one of the articles to be read by each student prior to the first Investigation 4-4 class.
Adapted from “Heavy Backpacks Harmful to Students, Simmons Study Says,” Boston Globe, February 13, 2001, by Scott Greenberger.

Heavy Backpacks Harmful to Students, Simmons Study Says

You see it in every schoolyard in America: the slight hunch forward, the tucking of the hand under the taut strap, the tug and, finally, the struggle to stand up straight.

Students who use backpacks to carry heavy textbooks to and from school execute those moves dozens of times a day. Though most are used to the burden, a new study suggests many are doing themselves harm.

Fifty-five percent of the Massachusetts children surveyed by researchers at Simmons College typically carry loads heavier than 15 percent of their body weight - the limit recommended by the American Academy of Orthopedic Surgeons.

Though the researchers couldn't definitively draw a connection, one-third of the 345 children in grades 5 through 8 surveyed reported back pain that forced them to see a doctor, miss school, or skip athletic activities.

The students, who were recruited through Healthnet, a statewide Internet health education program, weighed themselves and their backpacks under the supervision of teachers.

"If your head is kind of like a turtle in a forward position, that will cause pain and make you more vulnerable to injury," said Shelley Goodgold, associate professor of physical therapy at Simmons. "We know that putting the backpack on will make you more vulnerable."

Though a heavy backpack isn't healthy for anyone, children are particularly susceptible to injury because their bodies are still developing, Goodgold said.

Ninety-four percent of the students in the -study carried standard two-strap backpacks, and most said they used both straps. But only 4 percent used the hip belt recommended by health professionals. Packs designed to give better support, such as those with metal frames, weren't popular among the middle school students.

The Simmons study comes amid growing concern about heavy packs.

In Melrose, school officials sent a letter to parents warning them about heavy backpack burdens. Northeastern University researchers have tapped Beverly High School students for their study on backpack back pain. And the US Consumer Product Safety Commission has reported that in 1999, more than 800 youngsters were treated in emergency rooms for backpack-related injuries.

"They shouldn't make us take all this stuff around," said 11-year-old Sean White, who looked like he might be swallowed up by his black backpack as he stood outside Richard J. Murphy School in Dorchester. “When I go to sleep sometimes, my back hurts."

But a heavy backpack isn't all bad, according to White. He said it comes in handy when he has to swing the pack at his 13-year-old sister.

Adapted from “Backpack May Spell Backache,” Current Health, September 2000, by Tamra Orr.

Backpack May Spell Backache

It hangs around with you almost every day. It manages to handle whatever you throw into it. It's cool. It's convenient. It's your backpack!

But guess what? The facts are in: Backpacks can be dangerous! Yep, that handy backpack just might be your own personal ticket to lots of back problems in the future.

"We are seeing students in the fourth and fifth grades who are complaining about backaches, fatigue, and (physical) stress," says Russell Windsor, M.D., a surgeon at New York City's Hospital for Special Surgery. Dr. Windsor is an expert in orthopedics (or-tho-PEED-ix; having to do with the prevention or correction of skeletal deformities).

What causes the complaints Dr. Windsor hears from kids? Backpacks that don't fit properly, backpacks that weigh far too much for kids to be carrying safely, and backpacks that are worn with the weight unevenly distributed.

How much are kids carrying on their backs? Many of them are carrying more than 25 percent of their overall body weight, and that is just too much. Experts like Dr. Seymour Zimbler - Associate in Orthopedic Surgery at the Children's Hospital in Boston, Massachusetts - recommend that you carry no more than 15 percent of your total body weight, and preferably less than that. What does all that mean? If you weigh 80 pounds, your backpack should not weigh more than 12 pounds. If you weigh 100 pounds, your backpack should tip the scales at less than 15 pounds. Any more than this will cause a lot of wear and tear on the muscles, joints, and ligaments of your shoulders, neck, and spine. That can mean pain today and real back problems in the future.

"If you have a 90-pound female carrying a 20-pound backpack, then the backpack weight becomes a medical issue," says Dr. Charlotte Alexander, an orthopedic surgeon in Houston. "We found one 10th grade female student with a backpack weighing 47 pounds!"

How much does your backpack weigh? Bring out the bathroom scale and find out. Put all the books you usually carry in it and then put it on the scale. Is it less than 15 percent of your weight? If you're like most kids, the answer is no.

Adapted from “Overstuffed Backpacks Are Giving Children Adult-Like Back Pain,” The Wall Street Journal, April 6, 2002, by Tara Parker-Pope.

Overstuffed Backpacks Are Giving Children Adult-Like Back Pain

THE MEDICAL COMMUNITY is weighing in on the debate about the amount of homework students are asked to do. The diagnosis: The problem isn't how much homework kids have, but how much they are carrying.

Doctors say they are seeing a growing number of children suffering serious back pain as the result of carrying around overloaded backpacks. Because children's spines are still growing, many fear the heavy packs and tilted gait they cause could lead to long-term back problems.

Injuries associated with backpacks have more than doubled during the past five years. More than 6,000 children are treated in hospital emergency rooms each year for injuries related to lugging heavy backpacks-and most are under 14 years of age.

The phenomenon even prompted the Congress of Chiropractic State Associations to declare April National Backpack Safety month.

A study by Akron General Medical Center weighed the backpacks of more than 400 fourth and fifth graders. The average pack weighed about 14 pounds. More significantly, the fourth graders were carrying about 15% of their body weight, while the fifth graders were carrying, on average, 17%.

MANY KIDS, however, carried far heavier bags. The study found that nearly a quarter of the children carried a backpack weighing more than 20% of their body weight. The equivalent would be a 180-pound man carrying nearly 40 pounds on his back, several times a day, five days a week.

"This is too much weight for kids to be carrying around," says Heidi Frasure, hospital research coordinator and one of the study's authors.

The trend is particularly troubling because children are now complaining of aches and pains that 'historically haven't shown up until people hit their 30s or 40s.

"Unfortunately children are carrying backpacks that are 25, 30 and 40% of their body weight," says New York City chiropractor John Vilkelis. "As the backpack gets heavier, they alter their posture more, they lean forward to support the weight, and it can cause all kinds of different injuries to their back and neck."

Andrew B. Marsh, physical therapist at the University of Michigan spine program, says he has seen kids as young as five or six complaining of back pain.

The problem, he says, is one of repetitive strain. Overloaded backpacks are carried by kids on their way to the bus stop, from the bus to the school, between classes, and on the way home – every day, five days a week.

Adapted from “School Backpacks Can Be Painful Burden,” Health Scout News, September 17, 2001, by Nancy A. Melville.

School Backpacks Can Be Painful Burden

Homework can place a heavy burden on kids in more ways than one. Experts warn that the load can be more than just a pain in the neck if proper backpack usage isn't followed. Injuries related to backpacks, in fact, accounted for more than 13,260 visits to hospital emergency rooms, doctors' offices and clinics last year, according to estimates and projections of the U.S. Consumer Product Safety Commission.

Although backpacks are still a highly recommended way of carrying books around, the improper use of them may defeat their purpose, explains Dr. Angela D. Smith, an orthopedic surgeon at Children's Hospital of Philadelphia. The problem is that many children using backpacks these days either don't use backpacks that meet the recommended parameters or don't use them appropriately, Smith says.

Among the most important recommended features are that backpacks have padded straps and a waist or hip belt. These devices prevent strain on the shoulders and help stabilize the pack in place. Straps are helpful to cinch in books that would otherwise sag out the back.

But just as important, Smith adds, is how books are placed inside the pack. If books are placed flat, or fall flat, as opposed to being upright, that's when problems with back strain can occur. But with the load positioned lengthwise and extending away from the body, your position must be altered or aches and pains can result, adds Dr. David L. Skaggs, an assistant professor of orthopedic surgery at Children's Hospital, Los Angeles.

"The further backwards you have the weight, the more it pulls you backward, so as a result you have to lean forward," he says. "The important thing is to have the heaviest stuff right against your back to keep the center of gravity above your pelvis," he adds.

Another problematic book-carrying practice is carrying a pack or bag on just one shoulder, says Skaggs. "If books are being carried with only one strap, it's an asymmetrical load that's placed on the back. And we know from long-term studies that asymmetry and leaning to one side is probably linked to back pain." Muscle strain is the main problem, explains Smith. You'll get some pain in your back and the body's response to the pain is to shut off the muscles or make them spasm. Then the muscles weaken because they've been in pain and now they can do even less work, so it becomes a downward spiral. Smith encourages building strength in abdominal and back muscles through exercises like stomach crunches, because simply being physically fit may not help alleviate backpack pain problems. Skaggs adds, however, that the daily chore of carrying the backpack around itself is often enough to build up the proper muscles. "The best exercise is probably just doing it," he says.

Even proper positioning can be undermined if a backpack is simply overloaded, however, the experts say. But proper weight limits can differ with each individual, Smith notes. "I steer away from making any recommendations in terms of how much weight should be carried because what works for one person may be completely different for another," she says. "My recommendations to kids are simply the same things I learned growing up about camping, and it's the same thing the Girl Scouts or Boy Scouts will tell you: Pack everything you need and then take away half of it," she adds.
Adapted from “Backpack as a Daily Load for School Children,” The Lancet, December 4, 1999, by Stefano Negrini, Roberta Carabalona, and Paolo Sibilla

Backpack as a Daily Load for School Children

34.8% of Italian schoolchildren carry more than 30% of their bodyweight at least once a week, exceeding limits proposed for adults. Given increasing evidence of back pain in children, the time has come to propose some limitations to backpack load.

Repetitive loading of the spine is a risk factor for low back pain not only in adults but also for children. The load that children most commonly carry is their school bag or backpack. Most studies of this issue have been published in non-indexed journals and have various limitations. Nevertheless, some results suggest that the backpack could be a factor contributing to low back pain in schoolchildren with sufferers carrying backpacks for more time and experiencing greater fatigue and difficulty. We aimed to quantify the absolute and bodyweight-related backpack load carried daily by schoolchildren.

We studied children in the school catchment area of Bresso, Milan. We ascertained the weight of the backpacks of all the year 6 children at school (n = 237, average age 11.6 years, 119 girls). The data were collected daily on 6 days at school (from Monday to Saturday) over a period of 3 weeks. The days included were not shown to the children or to teachers. The average load and the maximum load of the backpacks was calculated for each child, for the week, and the average of these measurements calculated for the total population.

Sixty-one girls attended our institute for further assessment after their parents gave informed consent; they were assessed by a single specialist in pediatric orthopedic rehabilitation with medical scales.

The average load carried daily by schoolchildren was 9.3 kg, and the maximum load was 11.5 kg. The average load was 22% of bodyweight and the maximum load was 27.5% of bodyweight; 34.8% of the pupils carried more than 30% of their bodyweight at least once during the week.

The average load and maximum load being carried by children are equivalent to an 80 kg man carrying daily a backpack with an average load of 17.6 kg and a maximum load of 22.0 kg (or for a 60 kg woman, 13.2 kg and a 16.5 kg, respectively). In Italy, labor laws restrict the maximum load that can be lifted during work to 30 kg in men and 20 kg in women. The limits are 20kg and 15 kg for workers aged 15-18 years. The USA recommended limit for adults is 23 kg, which is deemed to protect 99% of men and 75-90% of women. No limits have been developed for application in schools; the limits usually proposed for children, although scientifically unproven, (10-15% of bodyweight) are widely exceeded in everyday life.

Rates of low back pain in children are approaching those seen in adults. Although the economic importance of the problem is small at this age, the lack of certified limits for backpack carrying is shortsighted. Previous studies have shown that the backpack load contributes to low back pain in childhood, and our results suggest that a decrease in this load is advisable.

2. Copy the seven Part 2 backpack / back pain articles and assign one of the articles to be read by each Epi team prior to the second Investigation 4-4 class.

Adapted from Health – Reuters, “Most Parents Don't Know Weight of Child's Backpack,” by Charnicia E. Huggins, December 19, 2002.

Most Parents Don't Know Weight of Child's Backpack

Though some children may seem to literally carry the world on their shoulders in their heavy backpacks, new study findings show that many parents do not know what their child's book bags contain and are even less aware of how much the bags weigh.

The heavy bags toted back and forth to school each day may, according to previous studies, increase a child's risk of falling and other avoidable injury. In fact, more than 10,000 annual visits to the doctor's office or emergency room by school-aged children are backpack-related, the report indicates.

"Parents need to know what their children have in their backpacks and how much it weighs," lead study author Dr. Bryan Lane of the Scott & White Memorial Hospital in Temple, Texas told Reuters Health.

"Many children were carrying items that were not immediately needed at school and if parents will take the time to monitor backpack contents they may be able to reduce the amount of weight their child has to carry," he added.

His study involved 188 kindergartens through fifth-grade students.

On average, the children toted about 14% of their body weight on their backs each day, Lane and his team report in the January issue of Archives of Disease in Childhood. The bags generally became heavier as the children grew older. The lightest-weight bag was less than 2 kg (4.4 lbs) and the heaviest was 13.5 kilograms (30 lbs).

The American Academy of Pediatrics currently recommends that children's backpacks weigh no more than 10% to 20% of their body weight.

Students whose backpacks weighed more than 14% of their body weight, however often complained of experiencing pain in their back, neck and shoulders, Lane said.

Overall, seven parents said they weighed their children's backpack, the report indicates, but roughly one third of the students said that neither their mother nor their father had ever peered inside their book bags to see what they were carrying. These students' bags tended to be much heavier than their peers, and were filled with more textbooks.

In general, most of the backpacks contained reading books, other textbooks and folders, as well as extra clothing or lunchboxes.

It would seem that an easy solution to lighten the load on children's backs may be for them to use wheeled backpacks, but Lane found that children tended to pack even more items into their backpacks when they were on wheels.

Even worse, he said, children did not always wheel those backpacks around, but often carried them. "This negated any advantage the wheeled model may have offered in the first place," Lane said, adding that some schools did not allow children to use wheeled backpacks due to crowded hallways or to avoid tripping accidents.

In light of the findings, "parents remain the best advocates for safety promotion and should represent the group most likely to help to significantly reduce the number of backpack related injuries--by checking backpack weights and contents," Lane and his colleagues conclude.

Also, "parents need to make sure that the backpack is carried properly, with the straps adjusted to make sure the weight is carried up on the back, evenly distributed on both shoulders," Lane said. "Do not carry it slung over one shoulder, or so low that it is below the waist."

Adapted from Health Scout News, “Reporter Parents Ignore Heft and Contents of Kids' Backpacks,” by Nancy Deutsch, December 20, 2002.

Parents Ignore Heft and Contents of Kids' Backpacks

If you know of a child who appears to carry the weight of the world on her shoulders, you may need to look no further than her backpack to help relieve some of the burden.

Many youngsters carry a surprisingly hefty physical load on those tiny backs and shoulders, researchers say. And not only do very few parents actually know the weight of their child's backpack, but few ever look at the contents, Texas researchers report in a new study.

"Parents, look in your kid's backpacks. I think you'll be surprised," says Dr. Bryan Lane, a family physician at Scott and White Memorial Hospital in Temple, Tex., and one of the authors of the report, which appears in the January issue of Archives of Disease in Childhood.

The authors surveyed 745 students in elementary schools in Texas, from kindergarten through grade five, whose backpacks weighed 10 percent or more of their body weight. The children reported that only 4 percent of their parents had ever weighed their backpack, and 34 percent of parents had never checked their child's backpack's contents.

Those whose parents had never surveyed the contents carried significantly heavier burdens and more textbooks than those whose parents did check the contents. The most common item carried was a reading book, but students also carried textbooks, folders, extra clothing, lunch boxes, and electrical devices.

Although many physicians and parents will anecdotally report that children are hurt by the heavy weight they force onto their shoulders or backs, there are relatively few studies in this area, Lane admits. In another study as yet unpublished, Lane and others report that children carrying 10 percent or more of their weight in a backpack frequently complain of shoulder, back, neck, and other musculoskeletal discomfort.

Long-term studies are needed to discern whether problems later in life can be traced to consistently carrying heavy loads to school in younger years, and Lane hopes this study will prompt that research, he says.

Dr. Arya Shamie, an assistant professor in the department of orthopedic surgery at the University of California in Los Angeles, says the study "puts some attention to a potentially damaging activity we do as kids."

He says that if he sees a man at 40 with worn-out discs, he doesn't know if the damage results from having carried a heavy backpack for too long or incorrectly, but he thinks that "could be" the cause.

Lane says that many kids today carry more items than when their parents attended school, and may even be carrying band instruments and gym clothes to boot. He says that a child will start to feel sore if she is carrying more than one-tenth of her own weight. "That seems to be the line that triggered the discomfort."

Dr. Leonard Pollack, head of pediatrics at Henry Ford Health System in Detroit, has never thought to weigh his own children's backpacks, but thinks it's a good idea. He also thinks parents should talk to their child's teacher or school and find out why children are carrying so much. "Some of the lockers are very small," Pollack suggests. Or maybe "the child is afraid something will be stolen." He says schools need to look at where lockers are placed and whether heavy textbooks need to be brought home and back to school regularly.

Pollack was surprised to find so few parents go through their child's backpack. "I think parents need to be cognizant of what is coming home in the backpack. Parents ought to be keeping track of what the kid brings home from school, whether it's a weight issue or not," he says.

Aside from suggesting that parents look in their child's backpack and remove unnecessary items, Lane's group has developed an acronym to help students remember some rules about carrying a backpack properly. It's called SKILLS, and it goes thusly:

S stands for Selecting the right backpack that is full-sized with adequate back padding and wide straps;

K is to Know the limit of the weight that should be carried, and that the recommendation is that it be less than 10 to 15 percent of the child's weight;

I is to Inspect what is inside the bag and make sure only necessary items are there and packed properly;

L represents Lifting the backpack correctly by bending knees and facing the backpack when lifting it;

L is so students will Learn to adjust the straps on the back and check that the backpack rests on the back, as it should, and not below the waist;

And S is a reminder to Search for updates about safe backpack carrying from a family doctor or on the Internet.

Adapted from New York Times, “Heft of Students' Backpacks Turns Into Textbook Battle,” by Sam Dillon December 24, 2002.

Heft of Students' Backpacks Turns Into Textbook Battle

Lisa Hale seethes with righteous anger.

"I'm thinking about a lawsuit," she says. Her complaint? The textbooks and other stuff her eighth-grade son, Joel, carries to and from school are so heavy they rip his backpacks.

"Other parents know about this, but they don't do anything!" Ms. Hale fumes. She, however, believes in action, and typed a petition this fall urging authorities to lighten student backpacks. Standing outside the Wal-Mart in this suburb on the eastern rim of Los Angeles, she and her children gathered 2,000 signatures in a week.

America's educational debate usually revolves around teacher shortages, budget cuts, hallway violence and other weighty issues. But in recent months, as school boards and state legislatures have faced an outcry from thousands of parents like Ms. Hale, they have focused on weight itself: why students' book bags have gotten so heavy, and how to lighten them.

Last month, the Hemet Unified school board voted to confront the crisis by issuing students an extra set of textbooks; one for school, another for home. Gov. Gray Davis signed a bill in September banning textbooks that exceed a weight limit, starting in 2004, and legislators in New Jersey and Massachusetts have introduced similar bills.

"California tends to act first, and this thing is going to move right across the country," said Peter Barnes, a New Jersey assemblyman who wrote a bill limiting textbook weight that is now before the Legislature in Trenton.

Whether the California laws will do any good, however, remains to be seen. The Hemet board's plan to issue two textbooks per student is costly, and critics are attacking Sacramento's new textbook weight law as a quick fix that may never lighten a single backpack. So far, educators, parents, textbook publishers and other experts are far from consensus about what government should do — if anything.

In fact, well-intentioned measures aimed at solving other school maladies appear to have created this one. Textbooks grew heavier over the past decade amid the zeal of the education reform movement, as officials imposed thousands of curriculum requirements on publishers, who in turn enlarged page sizes and jammed texts with photographs and graphics.

At the same time, school officials aiming to eliminate stash points for weapons and drugs removed lockers from many schools, forcing students to carry all their school belongings to every class and home every night.

"This was government trying to solve a problem and unintentionally causing another," said Assemblyman Russ Bogh, a co-author of the California textbook law who acknowledges that it may not achieve its goal of lightening book bags. "By taking out the lockers, they've pushed everybody into backpacks."

The law's principal author was Assemblyman Rod Pacheco, who said he first grew concerned last year when he saw his children groaning under the weight of their packs. Mr. Pacheco originally wrote a bill appropriating $140,000 to study "the lack of school locker space, the weight of students' textbooks and possible alternatives to students carrying heavy backpacks." It passed the Legislature last year, but Governor Davis vetoed it, saying this was a matter best left to local communities. Mr. Pacheco, however, had discovered keen public interest in student backpacks. He had worked on legislative issues he considered more important, including an overhaul of a scholarship program that was, he said, "as significant as the G.I. Bill."

"But the textbook bill got a thousand times more public attention," Mr. Pacheco recalled. Calls and e-mail flooded his office. "I went on CNN, MSNBC, and a Canadian radio station. I was in the newspapers in India. I was on the BBC. The bill was even on Rush Limbaugh."

With the spotlight focused so intensely, Mr. Pacheco returned with another bill, which this time did not mess around with a study but moved directly to action, ordering the state to set maximum textbook weights by July 2004. Experts criticized the bill as "ordering up curriculum by the pound," but it prevailed, and Governor Davis signed it.

"Who wanted to be seen as voting for heavier school backpacks?" said Rick Blake, a spokesman for the publisher Harcourt Education.

The law is important because California spends more on textbooks than any other state, $354 million in 2000, about 13 percent of the total American market of $2.7 billion. As a result, many publishers make California's regulations the starting point in designing textbooks.

Stephen D. Driesler, a spokesman for the Association of American Publishers, acknowledged that textbooks had become beefier over the past decade, mainly, he said, because states had written detailed curricular rules. The list of "content standards" for California textbooks, for instance, runs to 470 pages.

Publishers considered printing on lighter paper and binding with flimsier materials, but concluded that weight savings would be insignificant and the loss in durability severe, Mr. Driesler said.

State Representative Louis L. Kafka of Massachusetts, who has put a bill limiting textbook weights on next year's legislative docket, said he hoped publishers would consider breaking down heavy textbooks into multi-volume sets.

But Mr. Driesler said that approach could add 10 to 15 percent to a book's cost. And he said the real problem was not how much each book weighs, but that because lockers were being phased out, students were now lugging all their books as well as extra clothing, CD players and, in one case, even a collection of rocks through the whole school day.

The new high school wing at the Hemet district's Hamilton School in Anza, Calif., for instance, inaugurated in 1999, has no lockers. As a result, Beth Anderson, a freshman, carries a pack stuffed with a half-dozen textbooks and notebooks, as well as her gym bag, to her geometry, English, biology, behavioral science and Spanish classes, on to basketball practice and home again.

On the first day of school last fall, Beth's mother, Carrie Anderson, weighed Beth's pack at 28 pounds, about 10 pounds heavier than the 15 percent of a child's body weight that orthopedists offer as a guideline.

Ms. Anderson and other parents began to press authorities to act. Meanwhile, Ms. Hale's son Joel, who says he rides his bicycle to school each day carrying 42 pounds of books, was going through backpacks.

"The bottoms would just blow out of them, or the straps would rip off," he said. That is when Ms. Hale began her petition drive.

Bill Sanborn, the president of the Hemet board, recalled a meeting in October with parents upset about backpacks. "I was the sacrificial lamb as the only board member present, and people were demanding answers," Mr. Sanborn said. "It was a rough night."

Dr. Phil Pendley, the Hemet Unified superintendent, organized parents, board members and educators to study the issue. One approach they considered was to encourage the use of rolling backpacks, which were ruled out because they crowd classrooms and can trip other students in hallways. Many districts, nationwide, have banned the use of rolling backpacks inside schools.

The Hemet board voted last month to buy an extra set of textbooks for some students, a measure that Mr. Pendley estimated would cost $700,000 to $1.2 million. The district's total budget is $119 million. Most districts across the country, facing budget cuts, would find that price prohibitive.

Ms. Hale says the two sets of textbooks will not solve the problem. She remains convinced that authorities should restore lockers, especially in schools that do not suffer from gang violence.

"Some worrywart came along and said, `Uh-oh, these kids might use lockers to store guns,' " Ms. Hale said. "They changed a system that worked well for half a century — and created a problem no one knows how to solve."

Adapted from Wall Street Journal,” Overstuffed Backpacks Are Giving Children Adult-Like Back Pain,” by Tara Parker-Pope, April 6, 2002.

Overstuffed Backpacks Are Giving Children Adult-Like Back Pain

Mr. Marsh is conducting a study comparing regular backpacks and those fitted with a device called the Kelty Back Balancer.

The study, sponsored by the device maker, asks 20 ninth and 10th graders to carry backpacks weighing 10% and 20% of their body weight. The kids walk on a treadmill for four, five-minute intervals. The study includes regular checks of heart rate and blood pressure, as well as photographs of the child’s posture.

Ninety percent of the kids who come through the study say the weight they’re carrying at the 20% mark isn’t nearly as heavy as the books that they carry every day,” Mr. Marsh says.

The Back Balancer, which costs about $30, is reminiscent of the wide belts weight lifters use. It consists of a plate that fits on the waist belt of a backpack. The plate pushes against the stomach, causing the abdomen to contract and bear more of the burden, taking the load off the spine and shoulders, says co-inventor Ed Kois, a physician at the Southern New Hampshire Medical Center in Nashua, NH.

Doctors suggest a child’s backpack should not exceed 5% to 10% of the child’s body weight. The worst pain is caused by one-strap backpacks that have become trendy among teenagers. Backpacks should always have two padded straps and at the very least an abdominal belt. Rolling backpacks are one solution, but some schools have banned the packs because they cause tripping in the halls and block the aisles in classrooms.

H.B. Dumeer, principal of Cromwell Middle School in Cromwell, Conn., has started his own battle against the backpack. He has the school nurse randomly stop children in the hall to weigh their backpacks. If they weigh too much, the nurse helps the students figure out what they don’t really need to carry.

He also invited parents in to meet with a chiropractor to discuss the damage heavy backpacks do to children’s spines. He has forbidden backpacks to be carried in halls and into classrooms – not only because kids were carrying too much weight all day, but because they also were bumping into each other and falling in the halls.

He has finally come up with a partial solution to the problem. He is spending $15,000 to buy math and science textbooks that will stay permanently in classrooms, so kids can keep their own copy at home for homework. It’s expensive, but Mr. Dumeer thinks the school may save money because it will mean less wear and tear on books.

“Just drive by any school as they’re dismissing,” Mr. Dumeer says. “You’ll just be amazed at how heavy these book bags are. You can just see the weight they’re carrying.”

Adapted from Health – AP, “Study Downplays Kid’s Backpack Injuries,” by Deanne Bellandi, January 6, 2003.

Study Downplays Kid’s Backpack Injuries

CHICAGO - Children are more likely to be hurt tripping over backpacks or being hit with them than they are using the bags to lug around heavy school supplies, a new study suggests.

While there has been growing concern about back trouble in children who carry loaded-down packs, researchers found the back was one of the least likely places where children were injured.

When kids did get hurt, about 23 percent of all injuries in the 247 children studied were caused by wearing, lifting or taking off a backpack, according to the study by researchers from the Cincinnati Children's Hospital.

"This result shows that the actual use of a backpack is not exceptionally dangerous, and efforts should be directed toward educating children on proper backpack safety habits rather than restricting loads and redesigning backpacks," concludes the study published in the January issue of the journal Pediatrics.

How much children carry to school and how they carry it has been the focus of some attention. California last year passed a law for standards on maximum textbook weights and some children around the country now use backpacks with wheels to roll - instead of carry - their books to school.

The study looked at backpack-related injuries resulting in emergency room visits that were reported to the U.S. Consumer Product Safety Commission (news - web sites) in 1999 and 2000.

The study acknowledges a limitation: By focusing on injuries that sent children to emergency departments, it misses those injuries diagnosed and treated in a physician's office.

For those years, the agency's data projected a national estimate of more than 12,000 injuries linked to book bags or back carriers, excluding infant-carriers and camping backpacks.

In this study, researchers focused on a sample of 247 children between the ages of 6 and 18 with backpack injuries.

Tripping over a backpack accounted for 28 percent of the injuries, while wearing one or being hit with one each accounted for about 13 percent.

Properly stowing away backpacks at home and at school could have prevented many of these injuries, said researcher Dr. Eric Wall, a pediatric orthopedic surgeon.

"The floor is no place for a backpack," Wall said.

Backpack-related injuries that landed children in the emergency room ranged from cuts on the face and head to jammed fingers and fractures to shoulder strains and ankle sprains.

The combination of wearing a backpack and sustaining an injury to the back accounted for 6 percent of the injuries. However, 19 shoulder injuries were linked to wearing, lifting or taking off a backpack.

That's why the American Chiropractic Association's Jerome McAndrews said children still need to be careful about how they carry their backpacks and how much weight they put in them.
Adapted from Health – Reuters, “Backpacks Not Always to Blame for Kids' Back Pain,” by Kathleen Doheny, August 19, 2002.

Backpacks Not Always to Blame for Kids' Back Pain

SAN DIEGO (Reuters Health) - Parents often warn their school-age children not to carry heavy backpacks, worried that they'll get backaches. But a new study has found that the load on the back is often not the culprit when youngsters develop low back pain.

Children with emotional or behavioral problems, as well as those who frequently complain of stomachaches or headaches, are more likely to have low back pain than those who tote around a heavy backpack, researchers reported Sunday at the 10th World Congress on Pain.

Like most experts, a research team from the University of Manchester in the UK figured that heavy backpacks would take a toll on children's back health. "Our hypothesis was that the greater the load, the more low back pain," said Gary Macfarlane, an epidemiologist at the University of Manchester and the lead researcher.

"But we found there is very little difference in risk of low back pain no matter how much you carry," he said. The heaviest backpack in the study weighed about 39 pounds, but most were about 13 pounds. And the kids who carried the heaviest packs, walked to school with them on, and carried them around all day did have a slightly increased risk of back pain.

But the real predictor of back pain was whether the children had emotional or behavior problems, or frequently reported stomachaches or headaches, according to Macfarlane.

"Those with conduct problems were at three times the risk of developing low back pain," he said, compared with those who carried heavy backpacks. "We know that psychological factors can predict the onset of low back pain in adults," Macfarlane said, and this might be true in children as well.

The team went to 39 schools, recruiting children ages 11 to 16. The investigators weighed students' backpacks on 5 consecutive days and asked the students questions about how well they got along with others and other psychosocial issues.

In all, 18.6% of the 903 children surveyed had low back pain.

As for backpack weight, Macfarlane stressed that it is not a good idea to load backpacks to any weight. "We're not saying carry whatever you want," he said.

But a backpack weighing up to about 25 pounds, depending on the age and size of the child, is probably fine, he noted.

The American Academy of Pediatrics recommends that backpack weights not exceed 10% or 20% of a student's body weight and recommends wheeled backpacks if possible.

When Macfarlane's research team reviewed medical records of the children with low back pain, they often saw notes advising the parents to caution children about not overloading their backpacks.

The message, Macfarlane said, might also be to keep in mind that the pain may be related to emotional and behavioral problems.
California Legislation







INTRODUCED BY: Assembly Members Pacheco, Bogh, and Frommer

Principal coauthor: Senator Speier)

Coauthors: Assembly Members Longville, Reyes, and Zettel)
FEBRUARY 21, 2002
An act to add Section 49415 to the Education Code, relating to pupil health.


Textbook Weight
Existing law requires the governing board of a school district to give diligent care to the health and physical development of pupils.
This bill would require the State Board of Education, on or before July 1, 2004, to adopt maximum weight standards for elementary and secondary school textbooks.


SECTION 1. The Legislature finds and declares all of the


(a) Backpacks of elementary and secondary school pupils often contain textbooks, binders, calculators, personal computers, lunches, a change of clothing, sports equipment, and more.
(b) Elementary and secondary school pupils are carrying backpacks weighing as much as 40 pounds.
(c) Chiropractors, physical therapists, and pediatricians are seeing an increased number of children for spinal column injuries, non-traumatic back pain, and significant postural changes from overloaded backpacks.
(d) Chiropractors and pediatricians recommend that backpacks not exceed more than 15 percent of a pupil's body weight.
(e) In 1999, more than 3,400 pupils between 5 and 14 years of age, inclusive, sought treatment in hospital emergency rooms for injuries related to backpacks or book bags according to the United States Consumer Product Safety Commission.
SEC. 2. Section 49415 is added to the Education Code, to read:
49415. On or before July 1, 2004, the State Board of Education shall adopt maximum weight standards for textbooks used by pupils in elementary and secondary schools. The weight standards shall take into consideration the health risks to pupils who transport textbooks to and from school each day.

AB 2532 AUTHOR: Rod Pacheco

TOPIC: Textbook Weight

DATE: 08/28/2002


FLOOR MOTION: AB 2532 Pacheco,Rod Concurrence in Senate Amendments
(AYES 71. NOES 0.) (PASS)
AYES: Aanestad Alquist Aroner Ashburn Bogh Briggs Calderon Bill Campbell John Campbell Canciamilla Cardenas Cardoza Cedillo Chan Chavez Chu Cogdill Cohn Corbett Correa Cox Diaz Dickerson Dutra Firebaugh Frommer Goldberg Harman Havice Hertzberg Horton Jackson Keeley Kehoe Kelley Koretz La Suer Leach Leonard Leslie Liu Longville Lowenthal Maddox Maldonado Matthews Migden Mountjoy Nakano Negrete McLeod Oropeza Robert Pacheco Rod Pacheco Pescetti Reyes Richman Salinas Shelley Simitian Steinberg Strickland Strom-Martin Thomson Vargas Washington Wayne Wright Wyland Wyman Zettel Wesson
ABSENT, ABSTAINING, OR NOT VOTING: Bates Daucher Florez Hollingsworth Nation Papan Pavley Runner Wiggins


AB 2532 AUTHOR: Rod Pacheco

TOPIC: Textbook Weight

DATE: 08/27/2002


FLOOR MOTION: Assembly 3rd Reading AB2532 Rod Pacheco By Speier

(AYES 22. NOES 9.) (PASS)
AYES: Alarcon Alpert Bowen Burton Chesbro Dunn Escutia Figueroa Karnette Kuehl Machado Monteith Murray O'Connell Ortiz Perata Polanco Romero Scott Soto Speier Torlakson
NOES: Ackerman Brulte Johannessen Knight Margett McClintock McPherson Morrow Oller


New Jersey Legislation


ASSEMBLY, No. 2440

(Sponsored By Assemblyman BARNES, Assemblywoman FRISCIA and Assemblyman VAN DREW)

An Act concerning backpack safety education for public school
students and supplementing chapter 35 of Title 18A of the New Jersey Statutes.

  1. The Legislature finds and declares that:


Backpacks of elementary and secondary school pupils often contain textbooks, binders, calculators, personal computers, lunches, a change of clothing, sports equipment and more;


Elementary and secondary school pupils are carrying backpacks weighing as much as 40 pounds;


Chiropractors and pediatricians are seeing an increased number of children for spinal column injuries, non-traumatic back pain, and significant postural changes from overloaded backpacks;


Chiropractors and pediatricians recommend that backpacks not exceed more than 15 percent of a pupil's body weight; and


In 1999, more than 3,400 pupils between 5 and 14 years of age sought treatment in hospital emergency rooms for injuries related to backpacks or book bags, according to the United States Consumer Product Safety Commission.

2. A board of education may include instruction on backpack safety in an appropriate place in the curriculum of elementary, middle, and high school students as part of the Core Curriculum Content Standards in Comprehensive Health and Physical Education. The Comprehensive Health and Physical Education curriculum framework developed by the Department of Education shall include sample learning activities and resources on choosing a backpack, packing a backpack, lifting a backpack, and wearing a backpack based on standards as set forth by Backpack Safety America.


Permits instruction on backpack safety to be included in the curriculum of elementary, middle, and high school students as part of the Core Curriculum Content Standards in Comprehensive Health and Physical Education.

3. Copy  Epi Log Worksheet for each student.

Detectives in the Classroom Name: _________________________
Investigation 4-4: Epi Log Worksheet Date: _____/_____/_____

Risk Management Strategies


Epi Team strategy to reduce the level of risk posed to the population by carrying heavy backpacks.

4. Copy Presentation Rubric for each student.

Presentation Rubric


Got It

Getting It

Will Get It Soon


All Epi Team members participate

Most Epi Team members participate

Some Epi Team

members participate

Use of Epi Talk

All use is appropriate and accurate

Most use is appropriate and accurate

Some use is appropriate and accurate

Consideration of Actual Risk

Thoughtfully Considered




Consideration of Perceived Risk
Thoughtfully Considered

Not Considered

Consideration of Acceptibility of Risk

Thoughtfully Considered


Not Considered

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