Spotting, Treating Pain in Children

  • Not all forms of communication can be heard which is why pain is difficult to spot in children. Young infants cannot say, "Hey mom, my head hurts." Toddlers may not have learned the word for pain yet. And teenagers may not be speaking to you at all. If complaints of pain cannot be heard, a caregiver for children must be on the lookout for other signs that pain is affecting the lives of young people.


    How young is pain felt or perceived by the developing brain? Pain becomes a signal in the brain before a newborn is born. Preterm neonates react to painful stimuli of a venous puncture. This reaction can be seen by special brain mapping techniques that measure changes in blood flow and oxygenation. Hospital staff in neonatal intensive care units must be on the lookout for pain. They know that when the potential for pain is present, the lack of a reliable form of communication becomes problematic.

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    When are other times that pain can be felt by children besides in the hospital from the poking and prodding of doctors and nurses? Far and away the most common cause of pain in children is related to cancer. The cancer itself can be the root of pain, but the treatments for cancer are also a frequent source of pain. Post-operative pain, chemotherapy-induced neuropathy, radiation-related tissue injury, and inflammatory reactions to infections or grafts are all potential sources of cancer-related pain.


    Thankfully not everything painful is related to cancer. Many children have headaches. Some estimate that 1 in 16 adolescents have migraine headaches. Some children have musculoskeletal pain. Some girls have severe menstrual cramps (dysmenorrhea) or even endometriosis. Fortunately, adult pains like diabetic neuropathy, trigeminal neuralgia, and herpes zoster are rarely found in children. Knowing these potential sources of pain can be helpful. But pain cannot be seen or heard, so how do you know a child is in pain?


    Pediatric nurses are some of the leading experts in spotting pain. The babies in pain will have a certain look - an "infant cry face" that screams pain. Tightly closed eyes, brows that are drawn together with bulging, squished features between the eyes, at the nose and cheeks; nurses know the look of an infant in pain. How does pain manifest in toddlers? Limb disuse can be one clue. Broader-based signs include failure to achieve developmental milestones like walking or changes in behavior. Parents need to be aware of all the indicators that pain is interfering with a child's life. Some pediatricians use the FACES pain rating scale or the OUCHER! Scale. As a child gets older, performance in school and engagement in social interaction may be affected by a painful condition. Children can have as much disability from pain as experienced by adults.


    Children can also start to self-medicate with alcohol, acetaminophen, ibuprofen, aspirin, or stronger. Watch out for the teenagers who are no longer talking to you, are taking matters into their own hands and are trying to control their own pain.  A young girl who has severe menstrual cramps and is taking too much acetaminophen can easily become the next medication overdose statistic. A young man with a shiny, new driver's license and recent football injury might be using alcohol to help control his pain. The silent pain of teenagers can become a silent killer too.


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    Pain cannot be heard, but it can be spotted in children. A vigilant lookout will be constantly scanning the face of a child. A parent or teacher should be mindful of developmental, social, and scholastic achievements. And all caregivers of children should be engaged enough to spot the signs that shout "Watch Out! Pain Ahead!"  Once pain is spotted, sound the alert, seek help and let the child know that you are listening to all forms of communication.


Published On: September 06, 2011