How To Know When My Child is in Pain
by Chantal Scott PT, DPT
Kids Place Central Pediatric Physical Therapist
Assessing pain in children can be difficult, especially for babies who can’t tell you what’s wrong or for children who may be cognitively impaired or non-verbal. Even for typically developing adults, pain can be difficult to pinpoint and describe. This is even truer for children. Pain is such a complex concept that each person experiences differently.
As the parent, you know your child better than anyone else. So rely on your knowledge of your child’s typical behavior to tell you when they are in pain by noticing behaviors that are out of the norm.
Signs of pain in infants:
- Upset facial expression including pouting or grimacing
- Changes in rate of breathing
- Withdrawal or stiffness with passive movement
- Crying that is not easily consoled
- Decrease in typical movements or sudden changes in quality of movement, especially unilaterally. (For example a regression from walking to crawling)
A study on the reliability and validity of pain assessment tools in children indicated that facial expressions were more sensitive indicators of pain compared with motor behavior. Several parents noted that a lack of expression, crying, or responsiveness was most indicative of pain in their children.
Signs of pain in toddlers may include:
- Crying
- Pointing to area of pain
- “Owie” or “ouchie”
- Decrease in level of activity
- Atypical movements
- Sweating
Some pain behaviors common to individuals with cognitive impairment include but are not limited to:
- Agitation
- Verbal outbursts
- Tremors
- Shivering
- Hypertonicity or increased spasticity
- Respiratory pattern changes such as breath holding
- Grasping
- Grunting
- Pain can also present as perseverant verbalizations, aggression nor agitation and self-injurious behaviors
References:
Malviya, S., Voepel-Lewis, T., Burke, C., Merkel, S., & Tait, A. R. (2006). The revised FLACC observational pain tool: Improved reliability and validity for pain assessment in children with cognitive impairment. Pediatric Anesthesia,16(3), 258-265. doi:10.1111/j.1460-9592.2005.01773.x
