Several factors besides age and development can affect an accurate assessment of pain. These include a child’s psychological and emotional state, the behaviour and temperament of the child, and the culture of the child and his parents.
The role of parents and, in the case of older children, their peers, can be influential on the assessment of a child’s pain. Children often take cues from their parents’ own pain behaviours; they have in part learned how to behave by watching their parents. Children are also aware of how they are expected to behave in certain situations and that expectation can affect the child’s response to pain and their way of showing or hiding it.
Situational and child factors that modify pain
Your child’s pain is modified by many situational, personal, and developmental factors. Each of these factors can influence the others. For example, what you and your child think about pain affects what you and your child do about it. Similarly, what you and your child understand about the cause of his pain affects how you both feel.
The factors that most influence pain depend on what your child is usually like when free of pain. For example, your child may be too young to understand the reasons why a painful procedure is necessary. Young children may automatically think that the procedure is being done as a punishment for their actions and can not yet make the connection to how this will help them feel better.
The following sections further describe the different factors that affect the assessment of pain.
Child factors: What your child is like
Pain is an individual experience. A child’s most basic characteristics will have an influence on how that child expresses and copes with pain. These characteristics include age, level of understanding, and previous pain experiences. Other characteristics that will also have an effect include gender, temperament, and family and cultural norms.
Briefly, cultural norms are thought of as the beliefs and behavioural expectations for a group of people, in this case in relation to the meaning of pain and expectations around pain management.
In other words, a six-year-old boy with little previous experience with pain, who is good-natured and who, by virtue of his family and culture, is expected not to complain, will likely have a very different perception of pain than a child who has different characteristics — for example, a teenage girl who has previously had to cope with chronic pain.
Emotional factors: How your child feels about being in pain
How a child expresses pain is always modified by the emotional context within which it is framed. To get a sense of how and to what extent emotions will influence pain, ask yourself the following questions about your child:
-
Is there stress and anxiety in anticipation of pain?
-
Does pain create a heightened distress?
-
Is there a fear of continuing pain or pain without known cause?
-
Does the pain create situation-specific stress, for example at school or during social activities?
-
How much frustration exists due to new limits on activities?
-
Are there underlying anxiety and depression issues with your child?
Behavioural factors: What you and your child do to lessen pain
Behavioural factors influencing pain comprise what the child, his parents, and other caregivers do about pain. These include:
-
responses to pain-induced stress
-
the use and effectiveness of pain-relieving therapies such as relaxation and distraction
-
how others around the child react to a painful episode
-
how much pain restricts activity such as sports or attending school
Cognitive factors: What you and your child understand and believe about pain
A child’s and a parent’s understanding and beliefs can have an influence on the child's pain. These include:
-
what caused the pain
-
how strong it might be and how long it may last
-
what you know about using medicines and other therapies to lessen the pain
-
how well you expect these therapies to work
-
what you believe triggers pain
-
what you know about sources of stress that may cause pain
-
what you know about reducing the stress in typical childhood experiences, including school, sports, and relationships