Chapter One Understanding Your Child's Pain As a parent or grandparent, it is unimaginably difficult to watch a child suffer, to want to relieve the pain but not know where to turn or what approach to use. Your frustration and anger, anxiety and fear are understandable. Yet these very human emotions, which are displays of your love and concern, can get in the way of the very goal you wish to achieve: to relieve your child's pain and suffering. While health-care practitioners are usually successful at relieving acute pain -- a burst appendix, a broken arm, an abscessed tooth -- the same can't be said about chronic pain. If your child experiences chronic pain, you're probably feeling all the emotions we just mentioned.
The good news is, you can channel those emotions into positive, effective actions that can help you help your child. That's what this book is about: showing you how you can encourage your child to live his or her life to the fullest, with as little pain and discomfort as possible.
My decades of experience in working with children who live with chronic pain have shown me that even with the worst cases of childhood pain, we can still make a positive difference in the lives of these children and help make their childhood experience a more positive one. To make that difference, there are three main things you, as parents, need to do:
- understand the unique nature of childhood pain
- know where and how to get competent help for your child's pain
- have a comprehensive understanding of all the treatment options available to you
I firmly believe that in order for people to overcome an obstacle or beat an opponent, it's necessary to understand what they are up against. Childhood pain can be a formidable opponent, but armed with the proper tools, you can learn how to combat it and teach your child to have some control over it. In this chapter and the next, we explore the features of childhood pain so you will have a clear understanding of how pain works in young people. Be prepared to put aside some or all of your preconceived notions about childhood pain, and enter the world of childhood once again.
How Common Is Childhood Pain?
It's a fact of life: children get hurt, and they experience pain. They run through the house, jump off the furniture, tumble down stairs, fall off their bikes, and generally barrel through life. Along the way, they get cuts and bruises, sprains and strains, and sometimes a broken bone or worse. They also tend to experience bouts of minor medical problems, such as colds, flu, and earaches. In fact, during a one-month period, a normal, healthy child experiences about four acute painful events. Acute means the pain is short-lived and usually can be identified and described easily.
Thus, if your ten-year-old daughter has a tooth pulled, she can expect to feel throbbing pain after the Novocain wears off and will likely need to take ibuprofen for a day or two until the pain subsides. If your three-year-old son has his tonsils removed, he will experience postoperative pain for several days, which will be treated with painkillers and plenty of ice cream. And when your eight-year-old takes a bad fall from his skateboard and breaks his arm, the arm will likely heal nicely once it's set in a cast, and your child will quickly go about his usual activities, with some limitations for a while, but also proudly displaying his "badge of honor."
Children can also experience a more persistent or long-term type of pain. In fact, for an estimated 10 million children, pain is chronic or recurrent, which means it lasts for extended periods of time or recurs at regular or irregular intervals. (For the sake of simplicity, we will use the term "chronic pain" to describe both chronic and recurrent pain unless "recurrent" is specifically meant.) In otherwise healthy children, and in girls more often than in boys, recurring headache or migraine, abdominal pain, or limb pain can occur several times a week. The pain usually is not associated with a disease or other medical condition, but it is very real and can be debilitating. Other types of chronic pain in children can include facial pain, back pain, cancer pain, fibromyalgia, and others, which we discuss in depth in Chapter 2. (See "Pain in a Nutshell.")
Regardless of the source of or reason for chronic pain, it usually has a dramatic impact on children's lives and can cause them to miss school, sports events, family activities, and play time with friends. It has negative effects on their relationship with their parents, siblings, and friends, and can cause them to become depressed, withdrawn, fearful, and anxious.
In short, chronic pain can rob a child of her childhood and have a permanent effect on how she deals with pain as an adult. It can change a child's life if the pain and the child's relationship with it are not handled effectively. The good news for you as a parent is that you and your child can learn how to manage and treat pain in ways that will result in a more fulfilling and comfortable life.
What's Unique About Childhood Pain
Humans are complex beings, and the experience of pain is not the same for people of all ages. Researchers now accept that young people -- from the fetal stage through adolescence -- experience pain differently than do adults. There are several reasons why a child's pain is different from and in some ways unique when compared with adult pain. Understanding these differences and special features can help you better understand your child's pain and thus make you better able to manage it and help your child. Let's look at those differences.
Your son or daughter may be the spitting image of you, yet it's important to remember that children are not little adults and they are not you in a pint-sized version. That means their experiences with pain aren't miniature either, but they are different. To help you understand why your young children react to painful experiences the way they do, let's look at what's unique about childhood pain and some of the factors that contribute to how they experience and respond to pain.
Kids Experience and Express Pain Differently Than Adults
As adults, we are at an advantage when it comes to our relationship with pain. For one thing, we have a working definition -- "unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage," according to the International Association for the Study of Pain -- which gives us an intellectual understanding of pain. Such a definition means nothing to young children, although older teens may appreciate its meaning.
As adults, we have past experiences with pain that we can use as points of reference; for example, we know that a paper cut is just a minor irritation, while slicing a finger down to the bone is much more serious, and we know how to react appropriately in each case. Yet young children may cry equally loudly if these situations were to happen to them.
As adults we also know that pain can usually be treated successfully with drugs or an alternative approach. That is, because we have a vast store of reference, we know there is an end in sight. Young children, however, only know the moment, and imagine the pain will go on forever. The younger the child, the smaller his or her frame of reference, and so the fear of endless pain is more real.
So if a three-year-old cuts her finger and she is hurting, she doesn't have the capacity to understand that the pain is temporary, that the pain from the cut will fade quickly, and that in ten minutes she will likely be back playing again. She only knows that it hurts NOW, and her blood-curdling screams are not indicative of the seriousness of the injury, just how serious it is to her. Perhaps you can remember a painful injury or incident you had as a child and how you felt. If you can't, be assured that your perspective of pain was different then than it is now.
The bottom line is, children experience and express pain differently than adults because they have an entirely different frame of reference. One of the most obvious -- and most significant -- factors in that frame of reference is age.
Age: Preschool. Children's attitudes toward, perceptions of, and responses to pain change as they get older. Each and every time children experience discomfort or pain, they add the memory of the event to their databank of information. This doesn't mean they always understand the information they are gathering, but it is still added to the mix. These memories are important because they have a great impact on how children cope with pain for the rest of their lives.
Beginning around two years of age, children can verbalize their experiences with pain, often using words like "boo-boo" or "ouchie." (Before age two, parents and doctors must rely solely on how children look, sound, and react to get an idea of how serious pain is. We talk about how we measure pain in Chapter 2 under "How Childhood Pain Is Rated.")
At this age and up to about age six, children are learning about pain and what it means. Generally they are fascinated with any visible evidence of pain, such as scars, black and blue marks, scabs, and stitches. All wounds, big and small, are significant to them, yet it is the accumulated knowledge they gather from these types of events that will help them describe and quantify pain as they grow older. You'll see why this is important when, later in this chapter, we talk about how we measure pain in children.
Preschoolers are also learning about cause and effect. When a three-year-old child rides his tricycle over a bump, falls off the bike, and hits his head (while wearing a helmet, of course!), he will likely associate the pain with hitting his head and not the fact that he hit an obstacle that caused the fall. However, he is beginning to find reasons for his pain. While children can grasp the cause and effect associated with acute pain (if you play with matches, you c...
