I'm really worried about my 16-year old son. Every night he wakes up with back pain around midnight. He can't get back to sleep no matter what we do. Is this a sign of stress or just growing pains?

In the past back pain in a child or adolescent was thought to be uncommon and always considered a serious problem. Studies now show that children have more episodes of back pain than ever known. Even so, back pain in young people is still a yellow (warning) flag.

Certain symptoms are especially predictive of a more serious problem. Fever, night sweats, constant pain, and night pain fall into this category. When two or more of these symptoms occur together, cause for concern rises. The presence of all four symptoms must be medically evaluated.

Pain that is not relieved with analgesics or change in position also requires a medical exam. Likewise, pain that is made better or worse by eating is also a red flag. Check your son's temperature during the day and at night when he wakes up. Ask about symptoms with eating and any changes in bowel movements or patterns.

Your doctor will want to know anything like this out of the ordinary. Make an appointment as soon as possible. A specific diagnosis is needed before you can know what's causing this unusual symptom.