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Painful Kids!
There is nothing more heart wrenching than your child crying out in pain. It is difficult to assess children as they are often unable to tell you exactly what their pain is or it is hard to understand what they are saying through the tears.
How Do I Know My Child Has Pain?
There are three methods of measuring pain:
1. Self-report
2. Observer report
3. How the body reacts
None of these is perfect. Because pain is subjective, emotional, and individual, it cannot be measured in as precise a way as would be wished. However, these three methods of assessing pain in combination can give you an idea of the amount and type of pain a child is suffering.
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What your child reports - Although what your child reports about their pain is the most subjective measure of all, it is probably the most important. Since pain is individual, only your child knows what the pain is like for her. Injuries that look bad may not be that painful, and injuries or disease that cannot be seen at all may be very painful. Just because you can’t see the cause of pain does not mean that the pain doesn’t exist.
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What the observer reports - Your child is likely to express pain through changes in her behaviour. Parents can be especially helpful in assessing pain by observing behaviour changes. They are more familiar with their child’s normal behaviour than nurses and doctors who have no previous experience with the child. A child pulling on their ear may be a sign of pain. High pitched and persistent crying is a common sign of pain in an infant. A child not moving or guarding and protecting a part of their body may indicate that pain is present. Doctors and nurses may use behavioural pain scales, specific measures of behaviour such as movement and facial expressions, to determine the intensity of the child's pain. -
How the body reacts - Pain can also be assessed by measuring the body’s physiological responses. Typically, an increase in heart rate, breathing rate and the presence sweating, among other indicators, can be caused by pain. However, while useful, these physiological measures can also have other causes, and a person in pain may not exhibit these changes. Generally, physiological measures are used in combination with the other two methods of assessment.
Pain and emotion
The emotional component of pain is very strong. Pain is something to avoid and the possibility or anticipation of pain produces fear and anxiety. This connection between pain and the fear of pain is so strong that the emotional context in which we feel pain can moderate its intensity. In other words, fear of pain can make things more painful than if the fear was not present. At the same time, a lack of fear tends to reduce pain. To illustrate this, here are some examples:
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A toddler falls off a slide and immediately gets up seemingly fine. Their father rushes over and notices a small cut that is bleeding. When the child notices the blood, they start crying in pain even though there was no pain before. -
A ten-year-old boy feels a sharp pain in his toe and looks down. He realises that he’s stubbed his toe against the leg of a table. Understanding the source of his pain, and knowing that it is temporary and not serious, it begins to subside.
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An eight-year-old girl feels a sharp pain in her toe and looks down, but there is no table leg or anything else around that she might have stubbed her toe on. The cause of his pain is unknown and so, perhaps, the pain increases as her anxiety over the incident increases.
Helping children describe their pain
When it comes to your child describing their own pain, their age, individuality, and other factors must be taken into consideration. Children who have yet to learn to talk will not be able to describe details of their pain at all. Children with a limited vocabulary may use words like “owie” which must be interpreted by their parents and caregivers.
Children who are capable of expressing and describing their pain in detail may choose not to do so because of social pressures and cultural expectations. Children are sometimes taught that they should endure pain and that crying is for “sissies.” These beliefs, which can apply to all cultures and ages and to both sexes, may affect the way your child expresses and reports pain.
Often when asked a question children will answer with what they believe people want to hear. A child may play down the extent of pain to please her parent or other care givers.
Children may play down the extent of their pain out of fear. Your child may think that if she reports her pain as severe, she will be have to stay longer in the hospital, away from her family, friends, and home. In many cases, this may not be true.
The way children are asked about pain may direct them to an answer. For example, asking “that doesn’t really hurt, does it?” may cause your child to under-report her pain. If your child is not asked about pain, she may say nothing even though she is indeed in pain.
Two things may be done to increase the chances of an honest answer from a child. First, research has shown that if a child has been instructed on the importance of providing an absolutely honest answer before the question is asked, she is more likely to tell the truth. For example, before your child is asked to assess the amount of her pain, she should be told that “it is very important that you tell us about your pain so that we can help you.” Second, questions should be phrased as neutrally as possible, without any language that suggests answering one way or another.
If a truthful response has been encouraged to questions about pain, the responses should be believed. Children should feel they are part of the process of pain assessment and relief. Believing what they report encourages this feeling and helps give them and their parents a sense of control that is ultimately beneficial.
Pain management strategies
It is impossible to completely prevent children from having minor injuries or pain even though parents can and should make their child’s home and life as safe as possible. Speaking about safety and injury with your children can reduce the frequency of injury around the house and also help them be less fearful about pain.
During a painful incident, there is more than one way you can help your child. Depending on the cause, type, and severity of the pain, parents can use psychological or physical methods or medication for pain relief.
Physical methods: heat, cold, touch, and exercise
The use of heat, cold, and touch can be very helpful in reducing pain. Running cool water over a scrape or minor cut will not only help clean the wound, it will also cool the burning pain. The sound of the running water can also be soothing. A cool cloth on the forehead can help with a headache.
Warm baths, warm water bottles, and heating pads also can be helpful. Applying heat increases blood flow and can be very effective in relieving stiff muscles and joints, bruising, and sprains.
Ice can be immediately effective in relieving pain caused by bruising, muscle spasms and pulls, sprains, and insect stings. Ice acts like a mild local anaesthetic. Alternating ice and heat can also be an effective pain relief strategy for swelling, muscle spasms, and sore joints.
Massage can be helpful with painful muscle spasms and pulls. The sense of touch itself, especially a mother touching an infant in pain, is also helpful in reducing anxiety and pain.
Gentle exercise can be useful to help protect muscles from injury and encourage healing in injured areas. A physiotherapist can provide education and instruction.
Pain-relief medication
There are a variety of over-the-counter medications, or medications that do not require a prescription that can be effective in treating mild pain. Paracetamol (Panadol, Dymadon will relieve minor pains such as headaches, toothaches, and earaches. Ibuprofen (Nurofen) has an anti-inflammatory effect and will reduce pain associated with inflammation such as sprained joints, toothaches, and ear aches.
Parents should always be cautious when giving medications to children. A chat with your pharmacist is a good idea to learn more about the drug and how and when to give it to the child. Always read the label and follow the instructions carefully. Find out more about over the counter medications.
Any time you are unsure about your health don't forget to consult your friendly, local Pharmacist or Contact Us
