Help! My kid is in pain! How do I talk about it with him or her? (Part 2)

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It is not fun for anyone when kids, ‘tweens, or teens have pain. In an age group whose sole responsibility is learning, play, and exploration, pain can really get in the way of these things sometimes.

My favorite line is “My kid (or my friend’s) ’tween/teen hurts! What does this mean and what do we do about it?

In case you missed Part 1 of this blog series, I outlined what it means and why kids have pain. Since you’re probably proactive like me (otherwise, why would you be reading this?), let’s move on to “what to do about it.”

First and foremost-it is essential to give kids the opportunity to describe pain in based on their established communication skills. As mentioned in Part 1, many kids simply agree with what adults tell them to say about pain, while others learn metaphors of describing pain that don’t agree with their age or experience level. Example: the 11 year old who states her knee pain is “bone on bone” feeling. She’s too young to be using that metaphor appropriately. Most confusingly–some kids are too young to understand metaphors or communicate about their pain at all.

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Keep it age-appropriate:

  • Very young kids (ages 0-3): Pay attention to body language, behavior, play activity, and body mechanics. It is less likely that kids in this age group will misinterpret pain or use it as “manipulation” to get something they want. They also will be less likely to discuss it in any detail with an adult. Use the FLACC pain scale to quantify your observations.

    this scale is commonly used in babies and toddlers who cannot communicate their feelings. It is also used in other older patients who may have conditions that challenge their ability to communicate with caregivers.

    This scale is commonly used in babies and toddlers who cannot communicate their feelings. It is also used in other older patients who may have conditions that challenge their ability to communicate with caregivers.

  • Preschool (3-5): if they are old enough to draw, have them draw how they feel. Use toys, dolls, or stuffed animals to have the child act out their feelings. Use the FLACC or FACES pain scale depending on their ability to communicate their feelings.

    This scale is appropriate for children who can communicate using pictures, usually up to about age 10.

    This scale is appropriate for children who can communicate using pictures, usually up to about age 10.

  • Elementary school age (6-10): Continue to use drawing and acting as needed. You can start to give suggestions of metaphors to describe the pain. Example: have the child stretch a non-painful body part & feel the sensation of “muscle stretch.” Ask them if the pain feels like that (stretch, pull sensation). Most children at this age know of bruises and cuts (dull, sharp), so you can ask them if it feels like that. Older elementary school kids have a better understanding of muscle soreness, so you can ask if the pain is reminiscent of how they feel after a hard day in PE when their legs may be tired (soreness, throbbing). It’s still important to let them use their own words. The FACES scale is most appropriate for this age group, even up to age 10.
  • Middle school (11-14): Believe it or not, ‘tweens and teens in this age group sometimes have the hardest time describing their pain. They are transitioning from “kid role” into more “teen & adult” roles, which often leads to confusion they don’t even know they’re experiencing. They are balancing the desire to please adults with the desire to gain independence, test limits and rules with adults. Anxiety normally increases with puberty, middle school social pressures, and a rapid developing brain and emotional regulation system. Plus kids are often rapidly growing while participating seriously in one or more sports. It’s a perfect storm—and all of these things often lead to increased pain, injuries, and problems in this age group. Be very gentle when communicating with ‘tweens and teens. The numeric pain rating scale is appropriate but it’s important to understand that kids in this age group may report pain differently depending on where they are emotionally, cognitively, hormonally, and socially.
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  • High school & College (14-22): You thought young kids and middle school were challenging to understand pain? Welcome to adolescence and early adulthood! While teens and young twentysomethings are much more capable of complex thought processes and may have more experience with pain, they still may not be very adept at processing on how to communicate their symptoms with someone else. We also strike a dichotomy where many adolescents continue to aim to please adults, while others want nothing to do with adults. You know that teen—the one who thinks they know way more than you because they took high school anatomy and are chemistry whizzes. Or you have the teen (usually girl) who is unable or afraid to appear knowledgeable about her body. See my blog on this very subject here. She’s in 7 AP classes and aced the SAT, but has spent so much time becoming book smart that she has developed zero body awareness. She literally cannot tell you what is wrong with her, just that “it hurts, and I don’t know why.” You can talk calculus with her with ease, but getting info from her about her body is like pulling teeth. The numeric pain rating scale is appropriate for this age group, but bear in mind you’ll also have the teen/young adult who swears the pain is a 10/10 while maintaining a smile and seeming relatively at ease. See what I mean about not being able to communicate or understand pain?
  • When in doubt, have them use an emoji, since this is becoming the new language of kids, 'tweens, and teens!

    When all else fails, have your child, ‘tween, or teen communicate with emojis since this is probably their new favorite language.

Keep your game face on

Do not—-I repeat—-do NOT project your own fear and feelings about your child’s or your friend’s child’s pain onto him or her. This may be the hardest part, because I know this is not easy on you, either. Keep calm, maintain your game face, be objective and matter of fact, and help him or her exercise his or her own independence. This doesn’t mean you should avoid showing compassion or caring. Let him or her know that you’re concerned and will do whatever it takes to help him or her through it. This also doesn’t mean it’s not ok to be worried. This is normal and natural for you! Worry and cry about it in the comfort of your own private space.

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Leave the doctoring to the doctors

Stop it with consulting Dr. Google or posting on facebook about it already. This only adds to overdramatizing something that may or may not be dramatic. Consult a medical professional!

Emergencies are emergencies and cannot wait

If it’s clearly deformed, the skin is open and bleeding/oozing, the child or teen cannot put weight on the body part, it appears infected, or your inner voice says “something just doesn’t seem right”-please consult urgent or emergency care! See more on this in Part 3 (coming soon!).

Sometimes there is just not a straightforward diagnosis

If it has been ongoing for a long time, the child or teen has had every test in the book, and there’s still no medical answer, consider the role of your child’s perception of the situation along with his or her emotional processing. It is exhausting and confusing for him or her to go through the rigmarole of myriad tests and physician visits. Cut your losses and consider consulting a functional/integrative medicine practitioner, pediatric pain psychologist, or physical therapist who specializes in chronic pain in kids and teens. Chances are, your child or teen is so burnt out on medical visits that he or she has now integrated a “sick” personality: seemingly more depressed, detached, disinterested in normal age activities, less successful at school and sports. He or she subconsciously realizes the attention they get from being “sick” or “broken” and this becomes part of who they are. Trust me on this one!

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Keep it kid and teen specific, no matter what age they are

Remember that kids, ‘tweens, teens and young adults process pain very differently than you do, as do their developing bodies. Not all adult treatments that may work for you are appropriate for them, even when you swear by them. Let a medical professional, particularly a physical therapist who specializes in pediatric and adolescent injuries, pain, and psychology, make the decision for you on who or what to consult to help your child. Just because Johnny is 18 does not mean he is ready for an adult practitioner. Honor and consider that as you navigate his care.

Let someone else play quarterback

Let a medical professional skilled in dealing with acute pain and ongoing/chronic issues sort through this one and manage all the specialists and/or therapists you may need to see. It’s hard enough to be a rock star parent and it can really wear on you to try and be the manager of your child’s or teen’s health. Let the professionals play “quarterback” to manage the child or teen’s case. Most importantly and often not discussed-consider speaking with a family therapist or life coach to help you cope. It is completely natural, normal, and expected for it to hurt or stress you when you have to put on your smile/game face when your child or teen is suffering. Don’t be a hero—get help for yourself too. There is no shame in doing so and it’ll really pay off in the long run!

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Have resources nearby to help them understand and cope with their bodies

Stay tuned for a future post on helpful books and websites for all youth injuries, conditions, and pains. See Part 1 for examples of 2 books that are appropriate for parents of kids of all ages and middle school age and up. Some other helpful titles are Look Inside Your Body (Louie Stowell/Usborne books) , Magic School Bus: Inside Your Body (Joanna Cole), Understanding Myself (Mary C Lamia, Ph.D.), Sammy’s Physical Therapy Adventure (Michael Fink, PT, DPT), and the Be the Boss of Your Body Series (Be the Boss of Your Pain, Be the Boss of Your Stress, Be Fit, Be Strong Be You (Rebecca Kajander CPNP, MPH and Timothy Culbert, MD)

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Now that you know exactly how to communicate with your child or teen about his or her pain, you’re ready to take the steps to get him or her the right care depending on what is the problem. See Part 3 to understand the problem and determine where best to seek the appropriate care.

Disclaimer:

In an effort to conserve each person’s personal experience and beliefs about how to care for and deal with pain, I offer a bit of advice from the pediatric & adolescent healthcare provider’s perspective. It should be noted that I am not a parent nor do I fully understand all of the complexities and intricacies that go on in each family. Ultimately, how you discuss pain and teach your children and teens to deal with pain is a matter of choice and fully depends on each situation you encounter.