Many people have misconceptions or misbeliefs about pain in children. These myths have lasted even though there is now evidence to support that they are not true.
The most common myths on pain in children include the following:
Myth: Pain cannot be accurately assessed
Fact: While it is true that an absolute measure of pain is impossible because pain is personal, in the majority of cases an accurate pain assessment is possible, even in children. Depending on the situation and the age and health condition of the child, a pain assessment is possible using a number of valid and reliable self-reports, behavioural and composite measurement tools.
Myth: Pain cannot be accurately assessed in babies
Fact: While it is true that some children may not express their pain in the same way as adults, especially if they have not yet learned to speak, in most cases children are capable of expressing and identifying pain. A young child’s or baby’s behaviour provides clues to the amount of pain they have. These behavioural changes, including facial expressions, crying, and body movements, can also be used to determine the level of pain intensity in adults.
Myth: If a child says they are in pain but does not appear to be in pain, there is no need for pain relief
Fact: Because children cope in different ways, their behaviour is not necessarily an indication of their pain intensity. A child who has pain may be behaving normally. For example, a school age child may spend hours playing video games as a way to distract themselves from the pain rather than lying in bed complaining.
Myth: Children will tell you if they are in pain
Fact: Children may not report pain due to fear or a desire to please those around them. A child who does not report pain may do so in an attempt to avoid a further painful experience such as a needle. In addition, children may not report pain because they fear that if they do they may have to stay in the hospital or be separated from their parents. As well, children may not report their pain if they believe that it will displease their parents, siblings and friends. Older children may not wish to appear “weak” by showing their pain, especially in front of their peers.
Myth: Pain which has no known physical cause is a symptom of some kind of “mental or psychological problem”
Fact: Despite the continuing research, there is still a lot of work to be done before we fully understand what causes pain. Therefore, because we may not be able to identify a physical cause for pain, we cannot automatically assume that it is a “mental or psychological problem.” It is not particularly helpful to imagine pain as being a physical or a psychological phenomenon; pain is both a mind and body experience.
Myths and misconceptions about pain
As in all branches of medicine, research reveals new knowledge and opens new doors. As a result, treatment methods improve reflecting the new-found knowledge. The end of the twentieth century produced new evidence that substantially changed our beliefs and treatment ideas about pain. However, despite this new evidence, some old and incorrect ideas about pain persist. The following beliefs about pain have all been shown to be wrong.
Myth: Babies cannot feel pain
Fact: Decades ago, it was thought that a newborn's nervous system had not developed enough to process pain messages and therefore could not feel pain. Surgery without anaesthetic was not uncommon and the use of analgesics was thought unnecessary for what are now known to be painful procedures. Today, we know that a 26-week-old fetus has a nervous system sufficiently developed to feel pain.
Myth: Children are less sensitive to pain than adults
Fact: Younger children experience higher levels of pain than do older children and adults. For some, pain sensitivity seems to decrease with age.
Myth: Babies are incapable of remembering pain
Fact: Babies as young as six months old can show fear of painful situations, indicating a memory of the unpleasantness of pain.
Myth: Babies must learn about pain from previous experience
Fact: Pain requires no previous experience. A child's first injury will hurt; pain does not require an earlier episode to be painful.
Myth: Babies and children are incapable of expressing pain
Fact: Children may not express their pain in the same way as adults, especially if they have not yet learned to speak. But in most cases, children are capable of expressing and identifying pain. A child's behaviour provides clues to how much pain they are in. These behavioural changes include facial expressions, crying, and body movements. Studies have shown that children as young as three years of age can accurately use pain scales.
Myth: Children get used to pain
Fact: The opposite is often true. For example, children exposed to repeated painful procedures often experience increased anxiety and perception of pain with repeated procedure. Children with chronic pain may also become more sensitive to pain and other stimulation because of changes in the nervous system.
Myth: If a child can be distracted, they are not really in pain
Fact: Distraction is one of the most effective ways in which people cope with pain. If someone or something can distract your child, this is not an indication that the pain is not real. While most children must be taught this coping technique, some children spontaneously use this method to focus away from their pain.
Myth: If a child says they are in pain but do not appear to be in pain, there is no need for pain relief
Fact: Children are unique in their ways of coping. A child who is experiencing pain may be behaving normally. For example, school-age children may spend hours playing video games as a way to distract themselves from pain rather than lying in bed.
Myth: Children will tell you if they are in pain
Fact: Children may not report pain due to fear or a desire to please those around them. A child who does not report pain may do so in an attempt to avoid a further painful experience such as a needle. Also, children may not report pain because they fear if they do, they may have to stay in the hospital or be separated from their parents. Children may not report their pain if they believe doing so will displease parents and others. Older children may not wish to appear "weak" by showing pain.
Myth: Pain-relief medications are too dangerous and addictive for children
Fact: Fear of addiction or overdose is often given as a reason not to give opioids, such as morphine, to children. When appropriately administered, strong pain relievers are no more dangerous for children than they are for adults. Unlike substance abusers, children taking opioids do not develop a psychological dependence on them. It is this psychological dependence, or craving, that causes addiction. Longer-term use of these drugs may create a physical tolerance, so that larger doses are required for the same pain relief. This is not an indication of an addiction to the medicine. When the need for pain relief diminishes, a gradual reduction of the medication will be used to prevent any physical withdrawal.
On the same note, parents often worry about infants being given pacifiers and sugar water to relieve pain, but this will not become a habit either. Once the need for these measures is gone, children are not left with a craving for a pacifier or sweets.
Myth: Pain that has no known physical cause is a symptom of some kind of psychological or "mental problem"
Fact: Despite research, there are still things about pain that we do not understand. Not being able to identify a cause for pain does not mean that the pain is a "mental problem." Because pain is a complex interaction between the body and mind, it is not helpful to imagine pain as solely a physical or a psychological phenomenon. Pain is a complex interaction between nerves, emotions, thoughts, feeling, and physical activities.