Health care has long been concerned with developing strategies for alleviating adult pain but has only recently begun addressing the need for similar attention in dealing with children’s complaints.

“The field of pain assessment and management in children has evolved considerably over the last decade. There was a time when health professionals believed children didn’t experience pain—or if they did it wasn’t important since they wouldn’t remember it,” offers Professor Antonia M. Villarruel, The Nola J. Pender Collegiate Chair in Health Promotion director, Center for Health Promotion, The University of Michigan School of Nursing.

The greatest obstacle in dealing with kids’ hurt is often their inability to express the problem clearly to adults. Ask a 40-year-old where it hurts and you’ll get a detailed dissertation, ask a two-year-old and you’ll soon discover one of the pitfalls of the language gap that exists between adult and child.

The challenge for parents and health care providers is to adapt their methods to a child’s developmental level. Many specialists in childcare now use alternative methods for eliciting information from children such as picture-or-number-based pain scales.

For parents, who represent the frontline in assessing distress, close observation of altered behavior—changes in sleeping and play patterns, differences in crying, lack of appetite, sleep disruption—is a key factor in identifying distress.

“For younger children, parents can always ask ‘where it hurts’ or they can use aids like face scales or numbers for older children. Asking children what makes it feel better or worse is also helpful. Simple comfort measures, like hugging, rubbing, rocking—all are effective in alleviating pain—as well as bringing psychological comfort,” offers Professor Villaruel.

Informing yourself about the routine aches and pains associated with a child’s development may also save you unnecessary trips to the doctor.

“The best thing parents can do is to become informed about how their children grow and to develop a good relationship with their provider so they can ask and anticipate issues,” counsels Professor Villaruel.

There are clear signs to look for in determining degrees of seriousness and when it’s time to call on the expertise of a pediatrician.

“If the pain interferes with usual life activities, such as going to school, eating, and playing, then it is more serious than the occasional complaint of pain that does not affect the child's life. We look for ‘red flags’ when we evaluate a child in pain, to ensure that the pain is not a sign of a serious medical condition. ‘Red flags’ include things like fever, weight loss, night sweats, localized swelling and risks for infection or cancer. Pain that wakes a patient up from sleep should be looked at more closely for serious disease than pain that bothers the child all day, but allows them to sleep through the night. Pain that has a sudden onset, is associated with trauma, rapidly gets worse, has fever or easy bruising along with it, or limits the child's use of a body part, should be checked by a doctor,” advises Dr. Kenneth R. Goldschneider, director of the Division of Pain Management Cincinnati Children's Hospital Medical Center.

The Oucher:

Developed in the ’80s by Dr. Judith E. Beyer and modified for Hispanic and African-American children by Dr. Villaruel and Dr. Mary J. Denyes, The Oucher is a pain scale designed for kids. Children indicate their pain levels by pointing to pictures of children’s faces in varying stages—from smiles to crying. Each face corresponds to a number from 0 to 10, 0 indicating no pain and 10 indicating greatest distress. For more information on The Oucher see www.theoucher.org.

Patience and sensitivity, above all, are necessary to getting to the bottom of why your child feels unwell.

“The chronic pain that we see in our clinic has its highest frequency starting in the early teen years. Girls are much more frequently affected than boys. Often the cause of the pain is not easily found, so people are sometimes quick to judge the patient as ‘crazy’ or a ‘malingerer’…” says Dr. Goldschneider.

“In our clinic we start with the premise that the pain is real, no matter if the cause is easy to find or impossible. Either way, pain that interferes with a child's life needs to be managed as best as possible, and that starts with believing that it exists.”