WHAT IS PAIN?
Physical pain is an unpleasant feeling from:
• physical injury
• damage (a cut or an injection)
• disease
However, some pain, such as pain from a migraine headache, may
happen without any obvious damage to the body. As well, sometimes we
cannot determine the cause of the pain a child is feeling.
Sometimes we use the word pain to refer to emotional or psychological
distress. This pain is important, but this booklet deals only with physical
pain.
Some doctors used to think that infants and very young children did not feel pain. We now know
that children of all ages feel pain. Even very premature babies feel pain. In fact, young babies
may be more sensitive to pain than older infants because the nerves that control pain are not fully
developed. Disabled children feel pain. Young children, babies and severely disabled children
may be more likely to have their pain not recognised and not managed because they cannot tell
people about their pain.
Sources of pain
Many different things cause pain. Injuries are the most common cause of pain in children.
Medical tests and treatments can hurt. Surgery causes pain. Some diseases can cause pain.
Children often have headaches, tummy pains/stomach aches, or leg pains that come and go. The
pains may be a sign of serious disease or may be painful but harmless. If you don’t know what is
causing these pains, it is best to see a doctor.
Stress can trigger headaches and tummy pains/stomach aches. However not all headaches and
tummy pains are from stress. Pain that comes from stress is real and hurts just as much as other pain.
Blood tests bumps and scrapes operations
injections broken bones
tummy pain
cancer
medical treatment
cuts
arthritis
IV’s/drips
headaches
medical tests
sickle-cell disease
6
MEASURING PAIN IN CHILDREN
There are three ways to find out how much pain a child has:
• what a child says,
• what a child is doing,
• how the child’s body is reacting.
To find out about these, we must ASK and LOOK.
the child (using their own words or using a pain scale to show how much pain
they have)
ASK the parents
the nurses/doctors or other caregivers who know the child best
what the child is doing (body posture, facial expression, protecting sore part)
LOOK AT how the child’s body is reacting (changes in heart rate, blood pressure, oxygen
level)
how the child’s behaviour has changed (is he or she more quiet or more
irritated than usual?)
Children can tell people about their own pain if they are asked in a way they understand. Parents
often have a good idea about their child’s pain too. If the nurse or doctor knows the child well
they might have a good idea about the child’s pain. However they
generally aren’t as good at estimating pain as the child or parents.
What a child says
The best way to measure pain is to ask the child how much he or she
hurts. Only the child with pain knows how bad the pain is. Children
should be asked about pain in ways they understand and encouraged
to tell how much pain they have. Children under 4 years of age can
often tell us that they are hurting. However, they usually cannot say
how much pain they feel. Over 4 years of age, children can often say
how they feel by using simple ways of measuring pain like the Poker
Chip method. With the Poker Chip method, children are asked to say
how many “pieces of hurt” they feel. One chip is “just a little hurt.”
The second chip is “a little more hurt.” The third chip is “more hurt.” The fourth chip is “the
most hurt you could have.” The child is asked how many pieces of hurt he or she has. What the
child says is checked by saying, for example, “Oh, that means you have a little hurt.”
For children over 5 years of age, drawings of pain faces are often best. Children point to a face
on the scale that matches how they feel. The child should be trained by asking how he or she
would feel following minor pains, such as a bump or a mosquito bite. The child is then asked
about how much a more serious pain would hurt.
Children who are 6 or 7 years old can use words such as “no pain”, “a little pain”, “a medium
pain”, “more pain” and “the most pain possible”. Slightly older children can also say how much
they are hurting by rating their pain on a 0-10 (or 0-100) scale. Zero is no pain and 10 (or 100) is
the worst possible pain.
What a child is doing
Often children show their pain by crying, making a “pain” face, or by holding or rubbing where
it hurts. This is typical of short, sharp pain, like needle pain or pain from a bump. Longer-lasting
pains may cause less obvious behaviours such as changes in activity, sleep or eating. Below is
the Parent’s Postoperative Pain Measure that contains a list of these types of behaviours.
Changes in more than 6 of these behaviours in a child suggests that they may have pain.
However, a child’s behaviour can change for reasons other than pain. For example, many of
these behaviours can occur because of depression.
