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We used individual participant data from four population-based birth cohorts from Denmark, Portugal, Italy, and Finland. Data on anatomical location, frequency, intensity, and pain-related functional limitations of spinal pain in children aged 7\u201318\u00a0years were analysed. Maternal educational level at birth was used as an indicator of the child\u2019s socioeconomic background. Socioeconomic patterns in spinal pain were quantified by the slope and relative indices of inequality. The prevalence of spinal pain varied from 4.6% (previous 3\u00a0months) in Portuguese 7-year-old boys to 92.3% (previous 12\u00a0months) in Danish 18-year-old girls. Prevalence increased with age, and females reported more pain than males. Among children reporting spinal pain, approximately 59% experienced frequent pain, 59% intense pain, and 35% pain-related functional limitations, with notable differences across cohorts and age groups. We found no consistent socioeconomic gradient in the prevalence of spinal pain. However, among children reporting spinal pain, socioeconomic differences were more apparent in pain frequency, intensity, and daily-life functional limitations, although the direction and magnitude of these gradients varied across cohorts.\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : Spinal pain is common in children and adolescents, but no consistent socioeconomic pattern was observed in its occurrence. Spinal pain appears prevalent across all socioeconomic groups, with inequalities emerging more clearly in the frequency, severity, and functional impact of pain, although these patterns varied across settings.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Paediatric spinal pain is common, but prevalence estimates vary widely across studies.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Evidence on socioeconomic inequalities in childhood spinal pain is mixed and inconsistent.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Prevalence varies markedly across cohorts reflecting both methodological and contextual differences.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Inequalities in pain frequency, intensity, and daily-life impact are more apparent than those in spinal pain prevalence.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  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This study was approved by the executive board of the EU Child Cohort Network in March 2023 (ECCNLC202379) and subsequently by each cohort included in the study. Ethical approval for the original data collection in each cohort was granted by the respective local ethics boards, and no additional ethical approval was needed for this secondary data analysis. DNBC: The Committee on Biomedical Research Ethics approved the DNBC. This study was also approved by the DNBC steering committee (ref. 2024-03LC). G21: The G21 birth cohort study approved by the Ethics Committee of Hospital S\u00e3o Jo\u00e3o\/University of Porto Medical School until the 10-year follow-up wave and thereafter by the Ethics Committee of the Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, both in Portugal. NINFEA: The Ethical Committee of the San Giovanni Battista Hospital and CTO\/CRF\/Maria Adelaide Hospital of Turin approved the NINFEA study (approval no. 0048362, and subsequent amendments). NFBC1986: NFBC1986 received ethical approval from Northern Ostrobothnia Hospital District Ethical Committee 108\/2017 (15.1.2018).","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All participants provided written informed consent. DNBC: All women who participated in the study gave informed written consent. The participants born into DNBC were informed about their participation, rights, and how to drop out when turning 18\u00a0years old. G21: Informed consent was obtained from all adolescents aged 18 and older, and from both caregivers and adolescents when participants were under 18. NINFEA: Informed consent was obtained from all the participants at enrolment and at each follow-up. NFBC1986: Informed consent was obtained from the participants and their caregiver(s).","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"800"}}