Epidemiological studies have shown that about 50% of children younger than 15 years have already experienced low back pain. In most cases, this can be attributed to either wearing overweight school backpacks or excessive sports activity on the one hand, as well as to forced sedentary position and inactivity on the other. If the pain is still present after a few weeks, we should start thinking about a more serious pathology of the bone – spine diseases. Associated systemic symptoms and signs in the youngest should raise suspicion of a possible intervertebral space infection or malignancy. Sharp pain spreading to the lower extremities in a teenager is often associated with fracture of the apophyseal ring or herniation of the intervertebral disc. Recurring back pain that occurs after sports and partly diminishes during rest is very suspicious of spondylolysis. An older boy with morning stiffness and a dull low back pain that is difficult to determine, could be experiencing the start of ankylosing spondylitis. This paper presents the disturbing signs that alarm us to think about a more serious spinal pathology, which is often difficult to manage.