When you’re a parent, there’s no feeling more helpless than seeing your child in pain. But physical discomfort is something we all go through, even at an early age—and it’s a necessary part of life. “No one wants anyone to suffer, especially a child, but pain is normal. It protects us from further loss [or injury],” explains Ron Litman, D.O., an anesthesiologist at The Children’s Hospital of Philadelphia. “Kids have to develop internal coping mechanisms to deal with pain—after all, no one will escape pain in their life.”
The best thing that parents or caregivers can do is to provide both emotional comfort and reassurance to their child that the pain is normal and will, eventually, go away. But what if your child is too young to communicate that she’s in pain? Or, how do you tell the difference between when your child truly isn’t feeling well—or maybe he just wants to skip a test at school? To better understand how children experience pain, and the best ways to help them handle it, we asked pediatric pain experts for their top advice.
While you might think a toddler, teen and 20something all feel pain in different degrees, we all actually experience pain in a similar fashion, notes clinical-based researcher Katherine S. Salamon, Ph.D., who works in the Integrated Pain and Wellness Program at Nemours/Alfred I. duPont Hospital for Children, in Wilmington, DE. “There’s not a physiological or a biological difference in how kids or adults feel pain. Rather, it’s in the expression of that pain that you see a difference.”
It’s important to think of pain as a learning experience, especially among younger children, says Salamon.If you touch a hot stove, for example, that shooting pain you’re feeling in your fingers is part of the automatic reflex sequence that tells you to move your hand, pronto. But how you interpret that event can differ drastically depending on your age, and what you take with you from that experience. “If I get a big reaction from my parent when I touch something hot, I may become more sensitive to pain than someone else who didn’t have that same experience,” said Salamon.
The acute pain that comes with scraping a knee or bumping a head is a typical event for most children, and rites of passage we all go through when we’re growing up. But chronic pain‚ which is persistent and recurring, is less common among children and can be more disturbing. The most common types of chronic pain in children tend to be musculoskeletal, headaches, and abdominal pain. About 20-35% of children and adolescents are affected by some form of chronic pain worldwide.
“Pain is very subjective,” says Salamon. Your pain might be a six on a scale of 1 to 10, but that six might be different from your partner’s, your doctor’s or your child’s. “I know what my ‘6’ feels like but I have no idea what someone else’s ‘6’ feels like,” adds Salamon. That becomes hard, especially when you’re in that situation of ‘Does my child need medical assistance?’ It becomes a tricky thing to navigate.”
Younger children often do better with nonverbal cues. For example, at the Pain Clinic at Nemours/Alfred I. duPont Hospital for Children, young children can identify their pain with a face-based scale, picking which smiley or grimacing face best matches how they feel. (Nurses then also write what the child’s face looks like on the same scale.) “That helps us understand subjective versus objective level of pain,” says Salamon. You can follow that same template, and draw a few faces on a piece of paper for your child, ranging from smiley to neutral and sad or in pain if your child is having difficulty reporting pain, she notes. Use that information your child communicated to better understand how much pain she’s in.
How much is that bellyache really hurting your son and how much of it is due to that math test he has tomorrow? Medical experts caution that if a child says he is in pain, he probably is experiencing discomfort. “There might be other underlying experiences or reasons for that experience of pain but when a child is saying he or she is hurting, we know that they’re hurting,” says Salamon. “I tell parents to look for recurrence of patterns.” Is he missing every Monday of school? Is she wanting to leave early to miss a specific class that’s happening on Tuesdays and Thursdays? Are there certain social or sporting activities that he tends to say he’s in pain before attending? “It might be helpful for parents to know if there is any patterns that do come up when a youth is reporting pain often,” says Salamon.
If you think the pain is more situational than biological, be empathetic. “Say ‘I know you’re not feeling well this morning. School’s really important so we’re going to get you there and if you need to call and come home, we can do that,’” suggests Salamon.
Bottom line: If you’re not sure what level of pain your child is experiencing, call your pediatrician and discuss the symptoms with your child’s doctor. If you’re concerned that it’s serious, take your child to get help.
Although pain might have the same biological basis, kids react in different ways depending on their age. Treating pain can be especially challenging for children who aren’t old enough to speak, so parents need to be aware of their child’s reaction and response. “Reach out to your pediatrician if you’re feeling like your child is not acting as he or she typically would,” says Salamon.
Signs of pain: Crying, being inconsolable with care that would normally make him calm or happy. Other signs include crying that’s insistent and may be higher pitched, making faces (grimaces, wrinkling brow, scrunching face), body posture that seems tense or stiff, legs pulled in or stretched out, or squirming as well as not eating, nursing, or sleeping well.
Soothe: Try calming activities like swaddling, rocking or holding your infant, playing music, singing, or distracting her with something else.
When to get help: If your infant is still in distress, it might be a sign that something else is going on that is causing pain, says Salamon. Call your pediatrician and describe your baby’s symptoms.
Signs of pain: Persistent crying, general fussiness, atypical behavior
Soothe: Remain calm while you assess the situation. You’ve probably watched your child fall down and then tried to determine if she was seriously hurt or not, says Salamon, and your response may trigger a different one from your child. “Children look to their parents to help them understand how to navigate the world, and that includes pain,” she adds. “If your toddler fell and you have big reaction, then the child is probably going to notice more pain, since they may be scared and trying to figure out what’s going on.” Try giving him some encouragement and say, ‘Okay, let’s get a Band-Aid and get you back to playing,’ rather than focusing on the incident or the potential pain, suggests Salamon. If the situation warrants it, you might place an ice pack or cold compress on any bumps or bruises.
When to get help: If your child gets back to playing without incident, it’s likely the pain or discomfort will be short lived. But if she’s limping or acting out of the ordinary, you should probably describe the injury and your child’s response to your pediatrician, says Salamon. Parents often worry a fall or bumped head may signal a concussion. If your child has hit his head, it’s important to monitor his behavior. If he is acting lethargic or tired, having difficulty transitioning to the next activity, and/or crying inconsolably, get in touch with your doctor. “If you’re to the point where you’re thinking about it, it’s always good to speak with the pediatrician just to review some of the signs and get more information.”
Signs of pain: Older children are pretty adept at communicating whether they are in pain. Ask them where it hurts, how much, and if something happened to cause the pain or if it gradually built up. Ask specific questions like, ‘Can you get up?’ ‘Can you walk?’ ‘Does it hurt more when I touch this area?’ “Getting more of that description is going to be helpful to learn more about what they might be experiencing as well as addressing questions they’re going to be asked when they see a medical provider,” says Salamon.
Soothe: Even older kids need reassurances, so acknowledge that you know they are in pain, it’s temporary, and that you are getting them help so that they feel better as soon as possible. On the other hand, your 15-year-old who just fell while jumping on a trampoline probably doesn’t want his parents freaking out or drawing a lot of attention to the situation. Be aware of your own emotional reactions and tone of voice when you’re helping your child.
When to get help: The same rules apply here as to younger kids. Kids and teens look to their parents/guardians for information on situations, says Salamon. Note that if your child plays a sport or suffers any sort of head injury, it pays to be extra cautious. Up to 20 percent in teens develop concussions, although most do not experience long term difficulties from the injury, says Salamon. A study presented at the 5th International Consensus Conference on Concussion in Sport found that female athletes who suffered concussions tended to require a lengthier recovery period than their male counterparts. Another study published in the Journal of the American Osteopathic Medicine found girls’ recovery tended to average more than twice as long (28 days) than boys (11 days average).
Kids feel pain for all different reasons, but these are some of the biggest triggers for discomfort.
Lugging around 20 pounds of books, computers, lunchbox and more can definitely trigger back pain or muscle strain. Medical professionals often suggest children’s backpacks weigh not more than 10 to 15 percent of their body weight. If they absolutely must lug around all that stuff, get them a rolling bag.
Tablets and screens:
Too much screen time on smartphones and tablets can cause digital eye strain and headaches. The American Optometric Association (AOA) 2015 American Eye-Q survey found that 41 percent of parents say their kids spend three or more hours per day using digital devices, and 66 percent of kids have their own smartphone or tablet. Limit your child’s screen time, keep in mind their technology use if they complain about headaches, and make sure get an annual eye exam to help detect vision trouble.
If your child says it hurts when she goes to the bathroom, it could be a UTI. Urinary tract infections are when there is pain and burning during urination, which can also cause pain in the abdomen. More than 1.3 million children treated annually for the condition.
Stomach cramps or aches and difficulty going to the bathroom are typical signs of constipation. Make sure your child is drinking a lot of water and eating more fruits and vegetables. If the pain starts by the belly button and moves to the lower right side of the abdomen, it might be appendicitis. Talk to your pediatrician and see if she recommends taking your child in for examination or to the hospital.
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