Children and Pain

Last Updated: Sept. 1, 2003

Getting a shot in the doctor’s office. Skinning a knee. Suffering from a headache. In these and other encounters with pain, girls and boys may differ in how they behave, express their pain, and perhaps even how they perceive pain, according to Patricia McGrath, Ph.D., professor of pediatrics and director, Pediatric Pain Program, Child Health Research Institute, University of Western Ontario, London, Ontario.

Girls and boys have different pain responses
A child’s age, past experience with pain, and family and cultural styles, McGrath said, influences his or her response to new, painful situations. Parents serve as models. Young children often fall down, she observed, and then look at a parent for cues on how to react.

In general, the younger the child, the greater his or her overt distress, and the more the child has to be physically restrained, she said, the more painful the experience will be.

Sex differences in pain responses may be apparent but are not always explainable. Boys rate having braces tightened as more severe than do girls, for example, while girls rate having a broken arm as more painful than do boys. Even so, girls, in general, grade many procedures as more painful than boys do. In comparable situations, she said, girls are more likely to be fearful and anxious, and boys to be angry.

It sometimes is hard for health professionals, and even parents, to avoid causing children pain when attending to their health. But some strategies, she said, can lessen pain.

These include giving children as much control as possible over what is being done to their bodies. At home, a child could wash his or her own cuts with soap and water, and put on a bandage.

With age, children inevitably encounter a variety of pains that differ in quality and intensity. Their perspective on pain changes, and they generally become more adept at dealing with pain.

Those who think of childhood as largely a care-free time, however, may be dismayed to learn that in a typical month, a normal, otherwise-healthy child averages about four acute pains related to injuries and diseases – falls, sore throats, sprains – plus one achy pain, such as a headache or stomachache.

Many otherwise healthy and pain-free children, more often girls than boys, McGrath said, experience recurrent pain syndromes. These consist of episodes of headaches, abdominal pains, and limb pains as often as 3 or 4 times a week. In such instances, the pain usually does not reflect an underlying disease needing medical treatment, she said. The pain by itself is the problem.

Persistent pain problems in childhood may be predisposing factors for more debilitating pain in adulthood.

“In our clinic,” she said, “We teach children that what they know, do, and feel, can influence their perception of pain.” She and her colleagues try to improve children's understanding and control by giving them age-appropriate information, telling them, for example, that an injection will sting. They explain the rationale for what is happening, and they teach children simple pain-reducing coping strategies, such as active distraction.

Source: National Institutes of Health

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