How to assess pain in children, who can’t express or describe it clearly?

I recently met a young patient at a hospital. During my brief chat with him, he mentioned about his symptoms of a very mild headache, which occurred often. He did tell his parents about it.

Hearing him childishly describe his headaches, I realized how children struggle to explain pain symptoms making it equally challenging for their parents, who often do not know what to do – should they go to a hospital, meet a doctor, or wait it out at home, like this child’s parents did.

Pain is a frequent problem for children with complex medical conditions – but many of them are unable to communicate clearly. Headaches for one is common in children and usually not dangerous or disruptive but in some cases, it could be a symptom of a more serious health issue.

Parents should be able to recognize signs that indicate a potentially more urgent situation, especially when pain is repetitive or when something like a headache is followed with persistent vomiting & fever or neck stiffness, one should get prompt medical advice. Such headaches may not always be related to weak eye sight, a fall or head injury and may not offer any relief with over-the-counter pain relievers.

Even those children with severe chronic conditions, like seizure disorders and cerebral palsy; are also unable to verbally communicate their pain –  not able to clearly tell where it’s hurting, how much pain they are experiencing, or whether they are in pain at all. Most often their pain assessment remains inadequate and these children suffer unnecessarily.

While some common symptoms that prompt parents or caregivers to seek medical advice for their child are abdominal pain or distention (bloating), irritability, or other visible signs of pain. Often where children poorly describe pain are conditions like infections, including urinary tract infections, constipation, effects of medications etc.

Doctors recommend medical consultation, if pain occurs frequently and disrupts the ability to sleep, study, concentrate or participate in activities. Chronic pains should be medically treated.

Another problem is, most children experience pain very different from adults. It is safer to assess pain based on observable pain behaviors (facial expressions, crying). Sometimes even when the child appears to be sleeping there could be pain. Assessing pain in such cases depends on children’s own cognitive abilities and the behavioral assessments by parents.

Parents need to stay alert for potentially life-threatening sources of pain – while also not overlooking more common problems like infections. Even if a child complains of headache specially while studying, like this young boy did, please don’t assume it to be a regular excuse for his unwillingness to complete the homework, please consult a doctor to be safe. Evaluating pain symptoms in children is complex but surely needs attention.

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