Children’s Pain 101: Easy to understand answers to your questions

Nurses are experts at treating pain, and parents can be too. Are ready to treat your child’s pain like a nurse? This is a quick and easy guide to understanding children’s pain. I’ll help you learn about the basics of pain and how children experience it differently. We will address barriers to recognizing pain and how you can assess it at home. I will wrap up by discussing basic interventions you can easily implement.

Pain Basics

Defining Pain: What is it?

Pain is the body’s way of letting us know something is wrong. Pain alerts us when we come in contact with something harmful. An example of this would be an object that is sharp or something that is very hot. When we feel pain, we automatically move away from whatever caused the unpleasant sensation.

Why do we have pain?

Pain is the body’s way of letting us know something is wrong. Pain alerts us when we come in contact with something harmful. An example of this would be something that is sharp or something that is very hot. When we feel pain, we automatically move away from whatever caused the unpleasant sensation. 

What are the Different Types of Pain?

  1. Acute- Acute pain occurs suddenly. 

Examples of acute pain include breaking a bone or experiencing a cut on your skin. It could also be caused by an infection, or cramps. 

  1. Chronic- Chronic pain is pain that lasts over an extended amount of time. 

Examples of chronic pain include cancer, arthritis, and nerve and back pain.

Classifications of Pain

Pain can be further classified by what is its cause.

  1. Nociceptive Pain

This type of pain is caused by tissue damage. Tissue damage can be a result of injury or disease. Nociceptive pain can be acute, such as when you scrape a knee, or chronic, like in the case of arthritis. 

  1. Neuropathic Pain

This type of  pain is caused by nerve damage. Nerves are part of the body’s communication system. When nerves are damaged, pain signals are not getting sent and received properly. This is why you get symptoms of numbness and tingling, along with pain which sometimes has no visible cause. Examples of neuropathic pain include having a pinched nerve or shingles.

  1. Psychogenic Pain: This type of  pain is rooted in psychological issues such as anxiety, stress, fear, and depression.

How Does Pain Work?

Humans have pain receptors in their skin that respond to painful stimuli. These receptors send the message of pain up our nerves to the spinal cord. The message travels up the spinal cord to the brain. The brain then perceives the pain based on our unique experiences, psychology, and physiology.

It is important to note that everyone perceives pain in their own unique way. This means that stepping on a nail may be bothersome for some people, but cause intense suffering in others. 

Pain is subjective, meaning pain is assessed through our own personal experiences and opinions. You can’t tell me how much pain I’m feeling because I am the one who stepped on the nail. Even if you step on a nail yourself, you still don’t know how much pain the same stimulus causes someone else. 

Why Does It Matter That Pain is Subjective?

When our children complain of pain, it might be tempting to dismiss it. Our own experience with the same injury many have been different. We could say things like, “I’ve had a paper cut before and it’s not a big deal.”  Knowing that pain is subjective, can help us better empathize with our children’s pain. 

Key Point

Our children’s pain is what they say it is. We can’t judge how we think they should feel based on our own interpretations of pain. 

How is children’s pain different from adult pain?

Children are not just miniature adults when it comes to how they experience pain. They actually experience it differently than adults do. They have unique emotional and psychological factors that contribute to these differences. 

  1. Pain pathways in children are still in the process of developing.
  2. The number of pain receptors per square meter is more in a child than an adult.
  3. The amount of neuromediators is higher in children. (Neuromediators are chemical substances that communicate messages between neurons.)
  4. Children’s experience with pain is often limited, which means they have less experience with which to gage it.

What is the significance of these differences?

Some researchers believe that these differences mean children may feel pain more intensively and for longer periods of time. When we become aware that children could be more susceptible to pain intensity and duration, it highlights how critical recognizing and treating our children’s pain is. 

What are some of the barriers to recognizing pain in children?

  1. Limited Verbal Ability to express and describe pain

The younger a child is, the more difficult it can be to assess and recognize some of the subtle signs of pain. Babies may scream when they are in pain, but they can’t tell us where it is. Toddlers can point to their pain but may lack the vocabulary to describe it. 

  1. Anxiety Surrounding Pain

Children can have more anticipatory anxiety about pain because of past experiences. This may make it more challenging to separate what is fear-based and what is sensory-based discomfort.  

  1. Caregivers may be unaware of the more subtle signs and symptoms of pain

When a child is screaming, it’s easier to recognize they may be experiencing pain. More subtle signs such as irritability, or sleeping problems, may not be initially associated with pain. 

  1. Disbelief

There may be times when we legitimately question our children’s pain. Perhaps they are “faking” it to get out of going to school. Maybe they have lied about pain in the past. Disbelief can be a difficult barrier to overcome. 

  1. Kids can feed off parents’ pain perception

Children look to their parents for an example of how to react to pain. If a parent appears upset, a child can reflect that in how they respond to pain.

With all of these barriers, how can a parent know if their child is in pain?

  • Pay attention to your child’s self report
  • Watch for Physical Signs of distress
  • Watch for Behavioral signs of distress

Be aware of the signs and symptoms of pain 


  • Crying
  • Screaming
  • Grunting
  • Breath Holding
  • Changes in sleep patterns

     Young Children

  • Favoring an extremity
  • Decrease in physical activity
  • Changes in appetite or sleep patterns
  • Avoiding other children
  • Irritability
  • Misbehaving
  • Gasping
  • Wincing
  • Frowning            

Asking questions about your child’s pain shows that you are interested and that you care. It can help you decide if the pain is something you need to have checked out by a medical professional. It can help you decide which interventions you would like to try at home. 

Determine the severity of their pain  

How Using a Pain Scale at Home can help you comfort your child

Most of us have encountered a pain scale at one point or another. If you had your baby at a hospital, you were probably frequently asked, “On a scale of 1-10, how much pain are you experiencing?”

What is a Pain Scale?

A pain scale is a method of measuring or quantifying the amount of pain someone is experiencing.

Why is a Pain Scale Helpful?

A pain scale can give you a better insight into the severity of the pain your child is experiencing. You will want to adjust your interventions according to the level of pain your child is dealing with. For example, if a child only has a pain level of 1-2, you might want to try alternative pain relief methods instead of immediately reaching for Tylenol or Motrin. Conversely, if your child’s pain is scoring an 8-10. You are going to want to seek assistance. 

What are the different Types of Pain scales?

Two of the most commonly used in pediatric settings are: 

  1. The numerical Pain Rating Scale (This is more helpful with older children and teenagers.)
  1. Face pain scale (This is a visual scale where a child will point to the picture that best represents how they are feeling.)

How do I use a visual pain scale?

Once you have chosen the scale that you want to use, take the time to show it to your child. Point to each picture and help them understand what each means. Ask them if they have any questions about any of the pictures. Once they are familiar with the scale, ask them to pay attention to their body. Instruct them to point to the picture that best shows the amount of pain they are feeling.  

Depending on the picture they have chosen, their pain level will fall under four different categories.

  1. 0- No Pain
  2. 1-4 Mild Pain
  3. 4-6-Moderate Pain
  4. 7-10 Severe Pain

Knowing your child’s level of pain will help you determine which types of interventions you want to try at home. 

Once you have implemented an intervention, you will want to give it some time to see if it was effective. For example, if you tried using an ice pack on a sore knee, wait for 15 minutes or so before reassessing your child’s pain.

Reassessing Pain

Reassessing your child’s level of pain is a key step when using a pain scare. It can help give you a clear picture as to if your intervention was effective. In the case of using the ice pack, it would help you determine if this is an intervention you will continue to use. Reassessing will inform you if your child is feeling better or worse.

To reassess your child’s pain, present them with the same pain scale you used the first time.. Show them which picture they chose before to remind them. Now, ask them to pay attention to their body again. Have them point to the picture that best represents their pain. 

If their pain score remains the same or has gone up, you know that your intervention was not effective. It’s time to try something else. If their pain score goes down, then you know they are headed in the right direction. 

How can I help my child when they are in pain? 

Determine if this is pain that you can handle at home, or if you need additional medical attention

Pain caused by cuts, scrapes, and tummy aches can usually be treated at home. Pain caused by severe burns, deep lacerations, and severe abdominal pain, requires professional assistance. 

If you determine the problem is emergent, go and have your child seen as soon as possible. If you decide the issue can be handled at home, you can choose from many different types of interventions.

What are different interventions for pain relief?

Pharmacological Interventions

Pharmacological interventions are when you give your child medicine. This could be providing your child with a dose of Tylenol for a headache.

Physical Interventions

Physical interventions are activities such as applying hot or cold packs to an injury. Physical interventions also include massage and stretching.

Distraction Based Interventions

Distraction based interventions include passive and active play. Children can be very responsive to playing a game with a parent, or distracting themselves by watching a video. 

Mindfulness Interventions

Mindful interventions include practicing meditation or yoga. Using guided imagery and deep breathing also fall under the mindfulness umbrella.

Psychological Interventions

Psychological interventions could be contacting a licensed therapist. It could be less formal, such as discussing pain with your child. Listening to your child is also a psychological intervention. 

Once you have familiarized yourself with the many options you have, you can decide which one to try by considering the following.

How to choose an intervention

  1. Identify your goal

Are you trying to distract your child from pain, or would you like to help them get better rest? Deciding what you want to accomplish will help you determine where you want to direct your efforts.

  1. Take the child’s age into consideration

  If you are trying to comfort a baby, using a pacifier or a bottle are great interventions. For a younger child, reading a picture book out loud or playing with blocks can be effective distractions. A teenager may prefer a mindful walk or listening to relaxing music. 

  1. Ask your child

Identify some possible options and then consult with your child. Just giving your child choices is an intervention in itself as it gives a child more control over the situation.

What should I do if the intervention didn’t work?

Don’t give up! Try something else. Simply empathizing with your child’s pain can be helpful.

Consequences of not Treating Children’s Pain

Our children’s pain isn’t something we can blow off. Not treating our children’s pain can have negative consequences in the short and long term.

Short term effects of not treating Pain

-Altered mood

-Disturbed sleep

-Decreased or increased appetite

-Decrease in academic performance

Long term effects of poorly managed pain



-Impaired Social skills

-Self Destructive Behaviors

-Increased Stress

-Increased pain sensitivity

If your child’s pain is not being adequately controlled at home, take them to a medical professional and get additional help. If you are at a hospital and your child’s pain is not controlled, ask to see a pain management team. The answer of “there’s nothing else we can do,” should never be acceptable. Keep advocating for your child until they are comfortable again. No one deserves to suffer unnecessarily, especially our precious children.

Final Thoughts

Pain in life is unavoidable. It’s a protective mechanism to keep us from harm. Children’s pain should never be ignored. There are ways to assess it and determine your best course of action. When you have questions about your child’s pain; seek out expert advice. Sometimes finding the right intervention takes a little trial and error, but it is time well spent!

Looking for more ways to help your child when they are in pain? Check out my article on how to use a comfort menu with your child

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