My 5-year-old wears a heavily loaded backpack to school and I am concerned this is going to affect his posture. How much weight should he carry and how can I tell if his backpack is starting to affect him physically? It's amazing what children in school think they must carry with them and have available at all times. This includes textbooks (which seem to get bigger and bigger), school supplies (which must be tailored to meet each class's specifications) and the child's personal items such as MP3 players, etc. Backpacks have become the most popular and perhaps the most practical way for children and teenagers to manage all of their necessary school belongings. If used within a reasonable context, backpacks are a sensible way for children to transport their necessities. The concept of the backpack is that by wearing the pack on the back with shoulder support, the weight is distributed to some of the body's strongest muscles. If children wear backpacks improperly or consistently put too much weight in their backpack, they can certainly injure their muscles and joints. They may begin to complain of back, shoulder and neck pain and you may actually begin to see some changes in the child's posture. The American Academy of Pediatrics (AAP) has established some guidelines that can be helpful. These include: With the above suggestions in place, parents should routinely observe their child's posture and the amount, weight and type of material being carried in backpacks. If your child complains of back pain or you notice a difference in posture, they should be evaluated by your pediatrician. Even though the child's back pain is most likely due to his backpack, there are other causes of back pain that should be detected early. If your child does not use the backpack for a week, pain and posture changes should stop. If there is no way to avoid an overly heavy backpack, some other solution such as a rolling backpack or keeping a set of books at home should be considered.