Learn how to reach out to local schools and offer a backpack safety program for children

When I searched Google for child backpack safety, there were 105,000 links. Most were stories and articles from local television reports, the National Safety Council (NSC), orthopedic and pediatric associations, as well as our national and local chiropractic associations concerned about our children’s health and safety.

The purpose of this article is to encourage you to offer a backpack program to local schools, PTA groups, and church groups and to share the logistics of creating one.

As chiropractors, we focus on spinal hygiene and health, and there is no greater role than protecting our children. But consider this, the use of heavy backpacks is literally creating our next generation of patients. Therefore, it is crucial that we take a moment to consider how best to reach our patients and parents within our community.

Get the Word Out
First, gather the data to create a focused data sheet and presentation. Begin by searching the Internet and cut and paste articles relating to the subject. Be sure include the Web link and your sources. Compile the information and create a handout for patients and offer an evaluation for their children.

Using this format, create a letter for community advocates, such as school principals, church youth directors, community centers, and libraries. To find contact information of schools in your county, use the Internet. The same applies for searching houses of worship and civic and fraternal organizations. If nothing else, you are gathering a demographic profile of your community.

A letter with information material gathered by a Web search can be written like this: Millions of elementary and teenage students carry a backpack to school each day. While carrying a backpack to school every morning may seem harmless enough, it can cause painful back and neck problems and injuries for students who do not pack or carry their backpacks properly and worse carry too much weight. It can also lead to long-term health problems. In fact, more and more doctors are seeing children for back-related pain and injuries. Too many children are carrying more than the recommended 15% of their body weight and hurting themselves with chronic muscle and ligament sprains and strains. More than 7,000 emergency room visits in 2001 were related to backpacks and book bags. Approximately 50% of those injuries occurred in children aged 5 to 14 years.

As a chiropractor, I am acutely aware of the short- and long-term health concerns this may produce. Therefore, our office has established a community outreach program called Backpack Safety. There is no charge for this service; we only need the cooperation between the school administration and parents. I am enclosing a data sheet with Web-linked references for your review. A representative of our office will be calling in a few days to determine your interest and hopefully to set a date for these student evaluations.

The data sheet can include:

• When 200 New England school nurses were surveyed, 66% reported seeing students with pain or injury that could be attributed to carrying backpacks that were too heavy.
• The American Academy of Orthopedics stated that of the more than 100 physicians surveyed 71% felt that backpacks are a clinical problem for children; 58% have seen patients complaining of back or shoulder pain related to backpacks; 65% have recommended that a patient modify the use of a backpack to improve or correct a back problem; and 52% feel that backpack injury is a significant problem. (The survey was conducted amongst physicians from Children’s Memorial Hospital, Chicago and Alfred I. DuPont Hospital for Children, Wilmington, Del.)
• An Auburn University study reported that heavy backpacks might be a threat to spinal development. In the survey sample, the average pack was 17% of the child’s weight—67.2% of the children studied suffered muscle soreness, 50.8% back pain, 24.5% numbness, and 14.7% shoulder pain.
• University of Michigan researchers estimate that up to 60% of children will experience back pain by the time they reach 18.

Hopefully, the wisdom of these programs will reach the proper decision-makers. After a number of our letters were sent to area schools, we received a call from an elementary school nurse within 1 week. Two weeks later, a member of another school’s PTA was given our letter by the principal and called to inquire how my office could provide information to teachers and parents, as well as a sponsored backpack safety program.

This could stimulate additional programs for teachers, school administrators, and staff concerning stress and wellness management. Other doors open once you are in with professional presentations and positive outcome assessments. With our first backpack safety program, there is no doubt that any advice will be far-reaching. If followed, it will be immensely productive, providing awareness for the children, their parents, and community advocates.

Program Logistics
The following is a guideline for presenting a backpack safety program. I used a posture analysis and evaluation program, which includes a component called backpack safety with media material and a feature that captures the child’s picture and offers advice concerning the relationship between a child’s weight and the backpack. This feature is outstanding and sells the presentations.

You can also use material and equipment without a sophisticated computer program. All you need is evaluation tools, such as one or two scales, a calculator, and a data sheet to record your findings.

We met the school nurse in her office and placed two scales on the floor. To expedite the flow, as students entered the room, they were weighed without their backpack on one scale and with their backpack on the other scale for the weight difference. Data was recorded on the release form that was sent to their parents prior to the evaluation date. We then took digital pictures of the child, after which they were brought to me for my observations and recommendations. I recommended how much they should lighten their packs.

As they wore their backpacks and with the school nurse at my side, it was easy to recommend adjusting their shoulder straps correctly, discuss postural distortion, or demonstrate how a lumbar inflatable cushion or a rolled towel would help with support and posture.

I noted these observations on the release forms, as well as the obvious postural distortions, such as forward head carriage and high or low shoulders and hips. No student was evaluated without a parental release.

Considering that our first program was for third and fourth graders and the majority were at or exceeded the 15% of their body weight, imagine how much heavier their backpacks get as they progress through school. At this age, both teachers and parents must acknowledge the seriousness and adjust and react proactively. I recommended to the nurse and the principal that only necessary books be taken home and that each teacher consider the consequences.

The release form should be written on your letterhead (Figure 1) and include a map of your office location. A thank-you letter should be sent to the school nurse, principal, and parents. I also asked for letters from the principal and nurse thanking us for the program. These credibility letters can be used when sending introductory letters to venues throughout my community.

  Figure 1.

Sample letter to the principal.

This is a short note to thank you for approving our backpack safety evaluation. With statistics predicting that future physical and postural stress can be avoided or better managed if proper habits are created early, backpack safety has become a huge concern. Therefore, exposure and awareness is the first step. I hope our evaluations and the reports sent to the parents will stimulate changes and management.

Sample letter to the school nurse.

It was a pleasure working with you while evaluating your third- and fourth-grade students. They are lucky to have your ready smile and pleasant and caring demeanor.

I hope the parents will take advantage of the suggestions I mentioned on the picture analysis sent to every student we evaluated. If anyone has questions, they can always call me.

In the future, if a student, parent, or teacher has questions or concerns relating to their posture or stress, please feel free to have them call me for a complimentary consultation and evaluation or a referral to a medical specialist or chiropractor closer to the school or work.

Sample letter to parents.

It was a pleasure working with Mary Smith, the school nurse, while I evaluated your student for backpack stress.

Enclosed you will find a picture of your child and some of my suggestions after reviewing these pictures and evaluating their backpack at the school.

The common problem is backpack weight, which should not exceed 15% of the child’s body weight. I would say that half of those we evaluated were over this amount. Considering that these students are in the third and fourth grades and their books are not too heavy, just imagine the weight in later years. Good habits start early and I recommend you consider discussing this with your child.

Be sure shoulder straps are as high as comfortable, this will distribute the weight more evenly. Also, be sure that heavier books are at the bottom helping to balance the weight. Make sure the shoulder straps are not twisted nor used on one shoulder. If your child complains of lower back pain due to his or her backpack, roll a towel and place it between the backpack and their lower back to cushion the weight. Obviously, the first recommendation is to lighten the pack, raise shoulder straps and place books evenly. A rolling backpack would be best.

If you have access to the Internet, I am providing the URLs (below) for a few articles of interest. You can also find a wealth of information using a search engine and typing “backpack safety.”

• www.cocsa.org/pubs/news/87_635_2688.cfm
• http://faculty.washington.edu/chudler/backpack.html  
• www.schoolhealth.com/shop/mc_archive_backpack.asp
• www.jacksonsun.com/apple/200408_backpack.shtml
• http://abclocal.go.com/wtvd/health/080202_NH_backpacks.html
• www.workingwell.org/articles/backpacks.html

We are specialists concerned with postural and biomechanical stress and the neurological consequences of chronic irritation. There is no higher obligation as a community advocate than reaching our children. Start with your patients, their children, and their friends. Also, meet the decision-makers in your community. Children make great patients and your proactive attempt to stem the tide of future spinal stress is often far-reaching.

Joel E. Margolies, DC, has been in practice for 25 years in Atlanta and is the author of four books: Smart Start, Workshop Workbook, Chiropractic Marketing and Public Relations, and Personal Injury Workbook. He sends a free weekly chiropractic e-newsletter concerning practice management, public relations, and philosophy to more than 10,000 DCs in 31 countries. Margolies can be reached via email: joel3639@aol.com, or Web site: www.chirosmart.net.