Childhood Pain

My kids have pain.  It’s real.

One of the hardest things for me as a mother is to see them in pain and not be able to magic it better.

Take for instance my daughter this morning.  She had slept well and got up for school, coming down the stairs on her bum because her leg hurt.  As she started to get dressed she screamed and couldn’t bend her leg.  These things sometimes go as quickly as they come so with a big smile and the art of distraction I help her to get dressed, put on her shoes and brush her hair into a very simple ponytail, all without bending her leg.   She really needed support to get up off of the floor and actually get to the car.  I can see in her eyes that she’s struggling today.

In my head I am wondering if this is the day that I should let her wheelchair go into school to help her. By the time I’ve loaded up the car and locked the front door she is gently sobbing in the front seat.  Her left leg remarkably stiff compared to the right.  She tells me that she hurts all over.

By the time we get to school she can’t control her sobs.  We drop off her brother and I tell her that I will take her home and make her a bed on the sofa and we’ll try mummy’s wheat bag.  Her sobs resonate louder at the thought of missing school.  I try every trick in the book when I get home; distraction, hot pack, rest and relaxation, medicine.  After about an hour and a half she starts to feel a little better.

In the meantime my son gets out of bed, he has a training day today and has had a lie in.  He wakes feeling like he can’t support his weight, his legs feel like lead and he’s tired, really tired. All because he spent a few hours with a friend after school yesterday – this is his reward.  He needs to eat, drink and change position regularly, make sure that he exercises and keeps moving… even though it’s the last thing in the world that he wants to do.By the afternoon my daughter wants to go to school. To be honest the effort of her getting dressed combined with the energy required to think and converse with her friends might just finish her off again, so we talk about the things we could do instead while I carefully pace her afternoon.

Emotionally I’m drained but my smile is painted on my face but my positivity is forever present even though at points today I’ve wanted cry.  I’m so very proud of them both and the way they deal with their pain in such a constructive way.

Different types of pain…

In a child you may see the pain on their face or in their cries of distress or by the way they are holding their body and fidgeting.  Look closely and you may also notice an increase in their respiration, heart rate, blood pressure or avoidance of activity.  Pain also causes psychological changes in behaviour such as fear, grumpiness, sadness, anxiety and stress and is related to depression.There are different types of pain and it is important to understand the type of pain your child may be experiencing as that will impact how you deal with it.

Acute pain – starts suddenly and is short-term and It’s frequently caused by damage to tissue such as bone, muscle, or organs, and the onset is often accompanied by anxiety or emotional distress.  This could be a sprain, dislocation, subluxation.

Chronic pain – is felt over a longer period of time.  Chronic pain lasts longer than acute pain and is generally somewhat resistant to medical treatment. It’s usually associated with a long-term illness, such as osteoarthritis.  In some cases, such as with Ehlers-Danlos Syndrome, it’s one of the defining characteristic of the condition. Chronic pain can be the result of damaged tissue, but very often is attributable to nerve damage.

How is pain classified?

Nociceptive pain – pain caused by tissue damage.  Most pain comes from tissue damage. The pain stems from an injury to the body’s tissues. The injury can be to bone, soft tissue, or organs. The injury to body tissue can come from a disease such as cancer or from physical injury such as a dislocation or a sprain.

The pain that they experience may be an ache, a sharp stabbing, or a throbbing. It could come and go, or it could be constant and it may worsen when they move or laugh.  Pain from tissue damage can be acute, for example, injuries like a sprained ankle or subluxated wrist are often the result of damage to soft tissue. Or it can be chronic, such as arthritis or chronic migraines.

Pain is also classified by the type of tissue that’s involved or by the part of the body that’s affected. For example, pain may be referred to as muscular pain or joint pain.

Neuropathic pain – pain caused by nerve damage.  Nerves function like electric cables transmitting signals, including pain signals, to and from the brain.  Damage to nerves can interfere with the way those signals are transmitted and cause pain signals that are abnormal. For instance, you may feel a burning sensation even though no heat is being applied to the area that burns. Neuropathic pain is common in neuropathies such as Charcot Marie Tooth disease.

Breakthrough pain – occurs in between regular scheduled painkillers.  About 70% of people with chronic pain treated with pain medication experience episodes of what’s called breakthrough pain. Breakthrough pain refers to flares of pain that occur even when pain medication is being used regularly.

Psychogenic pain – pain that is affected by psychological factors. This includes the emotional, social and spiritual factors that also affect a person’s pain experience. Psychogenic pain most often has a physical origin either in tissue damage or nerve damage.

So what can we do to help?

I am trying to raise my children to approach the management of their pain in a positive way.  The type of support you will need to give as parents will depend on the age of your child and the type of pain they are experiencing but I try to make them increasingly independent in their pain management as the grow and develop.

It is important not to just tell your children to push through the pain.  Studies have shown that unrelieved pain causes the body to release certain chemicals that may actually delay healing, so it’s important to work with your child’s nurses and doctors to help control the pain. Non pharmaceutical methods have been shown to boost the effectiveness of medications in children.

I like to give my children the tools they need in their metaphorical ‘tool kit’ with easy access to these tools around the home, (except medication ) no questions asked.  Here are my top tips for helping children to manage their pain.

16 Top Tips for managing pain in children

#1 Acceptance
Believe them.  Acknowledge the pain is there, not by encouraging them to wallow in self pity but by encouraging them to say ‘I have pain what can I do to make this better’.  Pushing through pain or pretending that it isn’t there is not a good way to manage it long term.

#2 Communication
As your children grow they will not always be with you when they have pain.  They will have to communicate with the adults that are responsible for them.  Some children will find this easier than others depending on their age and personality.  Do the ground work for them.  Get a pain protocol in place at school.  Communicate with their teacher so that they are aware of any triggers to watch out for.  Make it easy for them to communicate, a child who is struggling with pain is often not the most articulate; try traffic light cards for younger children (green – good, amber – OK but hurting, Red – please help) or a medical pass for older children who don’t want to keep explaining in front of their friends.  Think about what may work for your child.

#3 Pacing
Feeding into the boom and bust cycle only serves to increase pain over time as does being consistently under active.  Getting this balance right is hard.  My children are all classic boom busters, they can find those reserves of energy when needed only to collapse in a heap when the fun is over which increases pain and fatigue.  Sometimes making them physically sick (my daughter after her swimming lesson or my son after a school journey), or may leave them sobbing unable to function.  Pacing the day to stop feeding into the pain is becoming my most effective way to manage it for them long term.

#4 Rest
Resting regularly throughout the day can actually decrease pain and help you to stay more productive overall.  Paced activity allows you to achieve maximum results and have less of a payoff later.  It’s important to re-directing them so that this is not seen as a punishment for the way that they are feeling but a little treat because they have worked hard.

#5 Changing position 
Being in one position for too long increases pain.  Changing positions between sitting and standing regularly throughout the day can help with stiffness.  The opportunity for regular times to have a stretch and stroll at school may help your child to manage pain across the day.
If hands get tired when writing, particularly as the demands of writing increase, taking regular breaks to stretch the hands can help as can mixing up the way that work is recorded between writing, typing or having a scribe.    Modified equipment such as pencil grips, special scissors and triangualr pencials can also help with hand pain.

#6 Posture and alignment 
Maintaining the correct alignment of the joints can really help with pain. Poor posture, adopting unusual sitting positions and having joints that are constantly moving beyond the normal range of motion places strain on muscles and soft tissues. This strain may increase tension in the muscles, which may in turn cause pain.  While my children say that they are comfortable sitting in these weird positions they all have pain that is aggrevated by it. To help they all stretch daily and have exercises that work on their core strength. They are costantly reminded to sit with ‘good legs’ or rather not to sit in a ‘w’ position  or one of the other strange postions that they find comfortable. Taping and eliminating postural strains can help.
 
#7 Sleep well
Having a good, regular bedtime routine is so important.  With absolutely no screen time and hour or so before bed.  In fact I’ve installed an app to everyone’s devices that actually turns them off at a certain time and then back on the next morning so I’m not constantly clock watching or rounding up iPads at bedtime.  A nice warm bath helps everyone to relax as does reading a book.  I try to keep it all stress free.  If the children get enough sleep it makes pain easier to deal with the next day.  This is not easy when pain can disrupt their natrual sleep cycles or cramp wakes them at night.  Try to keep these times calm, with the lights still low, voices soft and fuss to a minimunm so that they can drift back off to sleep as quickly as possible.

#8 Eat well
Often overlooked but extremely important is the correct diet.  Good nutrition is an important part of your overall health. A healthy diet should include a variety of foods, including fruits, vegetables, whole grains, low-fat dairy products, lean proteins and healthy fats. This gives your body the nutrients and energy it needs to function properly.  Eating small regular meals is a must.

Some foods have been proven to have anti-inflammatory and analgesic properties and can relieve pain.   These include Fish and other foods that contain omega-3 fats and antioxidant-rich foods such as coloruful fruits and vegetables.  I have found that eliminating certain foods from my own diet can help with pain.

#9 Hydration
Dehydration can have a huge impact on pain.  The body needs water to function properly even at a cellular level. Being dehydrated  can cause headaches and make many conditions worse such as constipation, arthritis, allergies and chronic pain.  It increases blood pressure as more blood is needed to reach the vital cells.

#10 Distraction
I use positive distraction all the time to focus my children attention away from the pain that they have. Usually activities that do not require too much extra energy at that time like listening to music, playing video games, watching TV,  creating stories, reading, puzzles, talking and drawing.

#11 Relaxation
Having a proper, regular, time to time to relax and decompress after a day at school or even throughout their day can go a long way to managing pain. Breathing exercises, listening to music or just collapsing on a beanbag.  Many children need a time to just let their minds wander and focus on nothing more than just being, forgetting about school, their friends, homework or their bodies.  The end of the school day before dinner is the time in my home when this has to happen.

#12 Wheat bags
Heat has long been associated with comfort and relaxation, it is great for treating chronic pain or an injury that is a day or more old, particularly in sore tight and stiff muscles and joints.  Heat helps the blood vessels dilate which in turn increases blood flow to the affected area.

#13 Cold packs
Ice is great for acute pain or a new swollen or inflamed injury.  Ice numbs the injury, the cold narrows blood vessels and slows down blood flow. This can reduce fluid buildup in the affected area. Ice is believed to aid in control of inflammation and swelling and relieve pain.

My kids know where wheat bags and ice packs are kept in our home if they need them and how to use them safely.  They are usually the first go to for pain.  Ice packs when a joint is sore or an ankle sprained and heat packs when they just hurt all over, have gastrointestinal pain or general aches.  The general rule if it feels right and helps then they have usually made the right choice.

#14 Warm water
Soaking in a warm bath is one of the oldest forms of alternative therapy and can work wonders for muscular-skeletal pain.   It makes you feel better, the joints looser, reduces pain, offers support for sore limbs, can decrease swelling and inflammation and increase circulation.  Try adding some Epsom salts to the bath which can also help if magnesium levels are low.

#15 Massage
Massage has long been considered an effective way to relieve pain.  It can increase blood flow to sore, stiff joints and muscles, which are warmed by the extra circulation and can also release natural painkillers in the brain.  It is a great way to relax your child as part of their bed time routine.

#16 Medication
Unrelieved pain causes the body to release certain chemicals that may actually delay healing, so it’s important to work with your child’s nurses and doctors to help control the pain.Do you have any top tips for dealing with pain? Let me know in the comments.

Check out these posts!

Pain – My own relationship with pain and how I’ve learnt to cope…

I decided to fight back but in a different way, this was an active choice for me.  It was only at this point that things started to change.  Over the last couple of years, in a slow steady process I have made positive steps to cope and to live.  Looking back I can now see what that it is a combination of lots of elements that have allowed me to change and maintain that change over time.

Meltdowns – Pain, fatigue and the impact on family life…

If someone had told me that my bright, articulate and fiercely independent daughter who had enjoyed two years settled at both playgroup and nursey would be be having daily meltdowns after school everyday I would have laughed in their face.
Written by Sarah Wells

Thanks for stopping by… My name is Sarah, I’m a mum, wife, writer, blogger, advocate and occasional public speaker. This is my blog, where I share our life with the world while raising my children to be happy with their perfect imperfections :)