How Do I Know My Child Has Pain?

girl looking sad 
There are three methods of measuring pain: self-report, observer report, and 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 parents and caregivers a good idea of the amount and type of pain a child is suffering.

What your child reports

Although what your child reports about her 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.

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 her 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 her 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.

Helping children describe their pain

When it comes to your child describing her own pain, her 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 in the most neutral way 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. For more information on all these different ways to relieve pain, see the pages in the "Treatment" section of this site.

Psychological methods

Because emotion affects pain, what a parent says and how she says it can have a great influence on how her child responds to pain. Acknowledging your child’s pain, “Ouch! That must hurt”, and being honest about what is happening, “I bet that’s going to need a bandage. Will you help me get one?” may help to reduce the distress and intensity of your child’s pain.

 Ask your child to describe the pain (sharp, throbbing, and so on), and how much it hurts. This will let your child know that you believe her and will give her a sense of control over the pain. It is important to listen to your child’s description. Involving your child in the treatment as much as possible by holding a bandage or helping rub on ointment, may be helpful.

If your child uses extreme language to describe the pain from a minor injury, acknowledge the description but restate it with less alarming descriptions. For example, if your child describes the pain as “killing me,” you should say “I bet that really hurts.” The language that parents use should be as hopeful as possible and should not contain anything that your child might consider judgmental or doubtful.

You should also remain calm: a child with a minor injury that sees their parent over-react may be encouraged to do the same, which in turn will make the child’s experience more painful.

Children can be taught relaxation techniques to help them cope with pain. Breathing, imagery, and distraction, all helpful pain-coping strategies, are described in detail in the “Treatment” section of this site.

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.

A more detailed description of these and other physical pain-relieving strategies appears in the “Treatment” section of this site.

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. Acetaminophen ( Tylenol, Tempra) will relieve minor pains such as headaches, toothaches, and earaches. Ibuprofen​ (Motrin, Advil) 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 the 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.

A more detailed description of these and other pain-relief medications that might be prescribed by health care professionals appears in the “Treatment” section of this site.


Lisa Isaac, MD, FRCPC