Kim Rehman says it is costing her "a small fortune" to buy two sets of textbooks for her daughter, Amber, a 10th-grader at Garrison Forest School.
But it's less expensive to buy duplicates than to take her daughter to a doctor or physical therapist frequently because of muscle spasms. The Rehmans, who live in Owings Mills, blame the weight of Amber's backpack - nearly 30 pounds of books and belongings - for the back pain that she has experienced since sixth grade.
"It was too much weight for her to carry around," Rehman said. "Everything she needs for class is in that backpack, including books, a calculator, tape recorder and binders."
Health experts agree that in recent years, backpacks have gotten heavier and are likely causing students back and shoulder pain. In response, public and private schools have taken steps to lighten the load. Among the solutions: two sets of textbooks - one for school, the other for home; using CD-ROMs instead of books for homework assignments; and requiring students to leave backpacks in their lockers during the day.
The Baltimore County public school system has developed a backpack safety procedure that was sent to school nurses in August. It included advice on identifying students who are carrying too much weight.
"We try to do as much education as we can about strategies that students can use with their backpacks," said Michele Prumo, coordinator for the Office of Health Services for the county schools.
She said the Maryland School Health Council keeps a list of the guidelines on how to use backpacks safely on its Web site.
Still, health experts and administrators concede that there is no magic solution. Students are carrying bigger books, athletic equipment, musical instruments and personal items. And those items add up to more than 10 percent to 20 percent of a student's body weight - the maximum load that each should be carrying, experts say.
Carrying too much
"It's pretty obvious that the students are carrying too much weight in the backpacks," said Luanne Kiersey, head of the health center at Garrison Forest in Owings Mills, who added that she sees girls who are hunched over and off balance because of their packs.
"I'll pick up a backpack on occasion and am surprised at how heavy it is," Kiersey said.
Among the schools that have taken steps to help students is McDonogh School in Owings Mills, where middle school pupils must leave backpacks in their lockers during the school day.
Some teachers also keep copies of textbooks in their rooms so pupils don't have to carry them, said Lynn McKain, public relations director.
Park School in Brooklandville provides its upper school students with a CD-ROM of the book, Janson's History of Art, to use at home, said Hillary Jacobs, director of advancement. The hardback edition is 1,000 pages and is left in the classroom.
At Friends School in North Baltimore, middle school Principal Scott Harrington said teachers are getting sets of books for classroom use only so pupils can leave large texts at home.
Students, meanwhile, seem to accept weighty backpacks as part of school life.
Casey Shellenberger's 36-pound backpack is only one of the heavy items that she carries around. The 15-year-old 10th-grade student at Notre Dame Preparatory School in Towson also plays the cello - which weighs 23 pounds - and brings it to school four days a week. She also carries a swimming bag. And, during the spring, she carries a duffel bag for softball gear.
"I kind of waddle," Casey says jokingly, but adds, "My back hurts a lot."
Miller Hughes, an eighth-grader at Roland Park Country School, stuffs her yellow backpack so full that she can't zip it. Miller, 13, who also carries a laptop computer and an athletic bag every day, said she can't hold onto all of her bags very long without putting them down.
Notre Dame Prep junior Catherine McGrain, 16, said most of her classmates carry backpacks everywhere because they have only a few minutes between classes. Catherine, who also carries a duffel bag for swimming gear, said she gets lower back pain sometimes.
Taking a load off
"I'd like to get the load off my back," she said.
Notre Dame Prep freshman Sabrina Davis did just that. Sabrina, 14, bought a rolling backpack - essentially, a suitcase with small wheels and handles - because the traditional kind made her shoulders hurt.
"The books weigh a lot, especially my biology and world cultures books," she said.
Rolling backpacks are usually found in elementary and middle schools, however; upper school students say they are "not cool."
At St. Paul's School for Girls in Brooklandville, Bronwyn Lewis and Danielle Solomon, 16-year-old juniors, conducted a study two years ago for their school paper. They weighed the backpacks of the middle and upper school students and discovered the average pack weighed 20 pounds and that about 70 percent of the students had some sort of back pain.
"The upper school students are still carrying around too much weight," Danielle said.
One recent study suggested backpacks might be responsible for more than strained muscles. The study, published in last month's issue of the journal Pediatrics, found that children are more likely to be hurt tripping over or being hit by backpacks being flung over a student's shoulder than to suffer back injuries.
Researchers said they found the most common injury was to the head and face, with back injuries ranking sixth. However, the study of 247 children who suffered backpack injuries from 1999 to 2000 focused on emergency room incidents and did not include doctor visits.
Kelly Daley, senior physical therapist at the outpatient center at Johns Hopkins Hospital, said students should make sure that backpacks are adjusted to their size and are not worn low on their backs.
"They should also listen to their bodies - especially if it involves any kind of pain," she said.
Jan Brant, who has spent eight years as the nurse at Park School, said some of the problems with heavy backpacks have been eliminated this year for upper school students.
Students now attend three 90-minute classes a day, which means they don't have to take every book home every night.
"It has lightened their load," she said.
The National Association of School Nurses has made these recommendations:
Do not carry loads greater than 20 percent of body weight.
Select a style that has padded shoulders and waist strap.
Use both shoulder straps.
Tighten the straps so that the pack is close to the body.
Distribute the weight of objects evenly in the backpack.
Utilize all compartments.
Pack heaviest objects close to the back with the center of gravity near the pelvis.