A child’s backpack is an amazing amalgam of fashion and function. As our children get solidly into elementary school and beyond, the look of the bag becomes as important as what is inside – and perhaps even more so. They must have some sort of magical power because they can hold a seemingly endless array of stuff. Given how large these bags become when fully loaded, it’s not a surprise that few backpacks are actually carried on backs. You’ll see them everywhere else, however: slung over shoulders, pulled on wheels, sitting on the ground, and even airborne. If your children are in any of these categories, then a lifetime of back woes likely has already begun.

Backpack’s are one of the leading causes of injury to children with more than 7000 children injured last year due to overloaded backpacks according to the U.S. Consumer Product Safety Commission. Back experts recommend that backpacks weigh no more than 10-15% of a child’s weight but many kids carry at least 20% of their weight. The type of injuries caused by backpacks are more varied than you may realize. The most typical injuries are shoulder and back strain from improper backpack use and overloading. Shoulders and backs are not the only part of the body at risk from backpacks, however. Many children each year actually injure their feet, toes and legs from tripping over heavy backpacks put on the ground to give their owner’s backs a break. Head trauma and lacerations have also been reported from children using their backpacks as impromptu balls. Backpacks indeed put the entire body at risk.

Helping our children not only choose a proper backpack but wear it correctly will dramatically reduce a child’s chance of injury. According to Dr. Maurice Albright, Pediatric Orthopedist at Massachusetts General Hospital, most back and shoulder pain in children is avoidable by simply wearing the backpacks correctly and resisting the temptation to sling the back from one shoulder. Additionally, the straps should hold the bag close to the body fairly snugly. Spreading the contents throughout all the compartments will help distribute the weight more evenly in the bag but in the end it’s the overall weight that matters.

Just like with clothes, backpacks are actually sized. Just like we would never have our children wear adult sized shoes, we need to be careful they are not hauling adult size backpacks. In addition to the weight of the actual pack, a fully loaded backpack may end up weighing more than your child! True outdoor stores such as LL Bean and EMS have lines of backpacks designed just for children but you can find similar items at local retail stores. When buying a backpack, there are a number of issues to consider. The ideal backpack will have wide shoulder straps and have straps for each shoulder; weight can not be distributed evenly over one shoulder and places too much strain on that one joint. Padded backs and waist straps are other features that help distribute the load in the bag more evenly. It’s also important to be careful the backpack itself is not too heavy.

Rolling backpacks can provide a relief from back strain. However, many kids walk to school and pulling a backpack may be difficult depending on the weather and condition of the sidewalks. And, many schools have multiple floors. Most kids, including teenagers, would have difficulty hauling a typical wheeled backpack up 1-2 stairs let alone an entire flight or more.

Part of the issue is certainly the amount of school materials kids need to trek to classes each day. Many schools strive to keep the school day flowing by not allowing kids to return to lockers between classes. As a result, many kids end of trekking a huge amount of weight all day long. If your child is in this position, talk to your child’s school about alternatives to help decrease the amount of weight needed to carry each day.

Keep in mind that while most backpack injuries are weight and use related, some are due to tripping over packs put on the ground. A few kids a year do break toes and sprain ankles and wrists from tripping over heavy backpacks put on the ground to give their wearer a much needed break.

If your child does complain of pain, ice and ibuprofen can provide short term pain relief but ultimately your child will need an evaluation by a doctor to make sure a more significant injury has not occurred. Any injury associated with a deformity or substantial pain should be evaluated right away.

So, as you embark on back-to-school shopping, add backpack fitting to the list and have kids try a few on for size and comfort. In the end, your child will find a backpack that provides the fashion statement they desire with the safety and fit features you know they need.