The purpose of this systematic review is to investigate back pain as a clinical presentation in childhood and adolescence providing the clinician with a comprehensive approach, which will enable for an early recognition of those spinal disorders in need of more aggressive medical intervention. The current literature suggests that young people have a fairly high incidence of non-specific back pain, which seems to be much more frequent than traditionally reported. In schoolchildren, low back pain is mainly associated with psychosocial factors and seems to be mostly benign and selflimiting, therefore, only occasionally requiring medical attention. However, young patients who seek medical assistance, have a higher incidence of organic conditions that can manifest with spinal pain as their predominant symptom. The evaluation of a child or adolescent presenting with back pain can be a challenging task and requires skilled clinical expertise and a high index of suspicion. The physician should have a carefully planned strategy for assessing the pediatric spine patient, which should be accurate, reliable, consistent, and easily reproducible in delineating spinal pathologies. This should include a detailed history, physical examination, radiographic imaging, and appropriate diagnostic laboratory studies. A specific diagnosis will be established in at least 50% of the patients. In certain cases, an exact diagnosis cannot be made, and it is always advisable to re-evaluate the child after a period of initial observation. By then more serious problems will advance and become more obvious while minor symptoms not linked to an underlying pathology will resolve spontaneously. The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or non-profit organization with which the authors are affiliated or associated.