The spine in children can be affected by different bone pathologies such as trauma, infection, and tumoral processes. Most typical however are postural deformities, of which the evolution is mainly influenced by growth. An overview will be given of the most frequent problems encountered in children. Back pain is not infrequent and should always be taken seriously. In recent years, however, there has been an increase in functional complaints, mainly due to stress-related problems. Improving imaging techniques allows more and more accurate diagnoses and should be used judiciously. Postural deformities should be divided into functional and structural entities. Functional hyperkyphosis, hyperlordosis, and scoliosis should be identified by a thorough clinical evaluation and certainly not be overtreated. A structural scoliosis has the most potential of creating cardiovascular or pain problems in later life. Not all curves however have a bad prognosis. It is the task of the clinician to identify the children needing special attention, based on their knowledge of the underlying pathology as in congenital scoliosis and of the physiological age or maturity of the child, especially in the adolescent idiopathic scoliosis. Treatment should be initiated according to the prognosis regardless of the age of the child.