Coping with pain

Many parents worry that their child will suffer a lot of pain from the condition or its treatment. Fortunately, we have learned many ways to control pain. It’s important for you, your child, and the treatment team to work together to reduce or eliminate as much of the pain as possible.

You will be able to help your child better if you are both prepared for potentially painful experiences, and you soothe your child when they are in pain. You know best how to comfort your child, but may wish to learn other techniques that have helped others. You can also assist the treatment team in putting together a plan to minimize the pain or discomfort. As part of this plan, the team may recommend medicines to prevent or control pain.

How can you tell if your child is in pain?

Children show pain in different ways depending on their age. You can probably sense when your child is in pain. Here are some general signs of pain that may also help you.

Babies (ages 0 to 1)

With babies, the key signs of pain are related to changes in behaviours. Babies may:

• move less than normal
• cry more often, or if they are touched or moved
• look pale and sweaty
• not eat well
• be irritable
• not have any interest in their surroundings

Toddlers (ages 1 to 3)

Toddlers can begin to talk about their pain. You can ask them about their pain, using words they already know. They can point to where it hurts. Because you can’t easily tell how much pain your toddler has, you will need to watch for changes in their behaviour also. Toddlers may:

• cry more often
• be irritable or fussy
• not play
• not eat well
• not be easily comforted
• hold a body part that is hurting
• have problems sleeping

School-aged children

School-aged children can talk about where they are hurting. You can also find out how much pain they are in by using the faces pain rating scale. Children can also express where it hurts by colouring on a drawing of a body. Some other signs of pain in school-aged children are:

• crying
• be irritable or fussy
• avoiding people
• have a “pained” face
• hold a body part that is hurting
• not be able to pay attention

Teenagers

Teenagers react to pain like adults. Some may talk about it, while others may try to hide it. Teenagers can rate their pain on a scale of 1 to 10, where 1 is mild discomfort and 10 is the worst pain possible.

Teenagers who are in pain may:

• become quiet
• have problems concentrating
• have problems sleeping
• not eat well
• become irritable or angry
• withdraw

How can you help your child prepare for painful procedures?

Preparing your child for painful procedures can reduce their anxiety and fears. This, in turn, can help reduce their pain. Here are some general strategies, followed by ideas based on your child’s age.

General ideas

• Talk to child life specialists or other members of the treatment team for ideas on how to prepare.
• Make sure that you prepare your child based on their age and understanding. Be honest.
• Try and be as relaxed as possible yourself before the procedure.
• Don’t place any expectations on your child on how they should react.
• Never lie about painful procedures. Your child will become scared and lose trust in you.
• Try to stay with your child during painful procedures if possible. This can be a big comfort for your child. You may be able to tell better than others when your child is feeling pain.
• If you can’t be present during painful procedures, leave familiar things from home with your child such as toys music, photos, audiotapes, and videotapes of you and your family. Others may be able to be there, such as a grandparent, aunt or uncle, brother or sister, social worker, child life specialist, or nurse.

Here are some other ideas to help your child prepare based on age:

Babies (ages 0 to 1)

• Try and make sure you are calm and confident.
• Try and be there to comfort your child.

Toddlers (ages 1 to 3)

• Tell your child what will happen using words they understand. Answer any questions honestly.
• Rehearse the procedure with a toy so your child gets experience during play. For example, you could use puppets or dolls to show where a central line might be placed.

School-aged children

• Tell your child what will happen using words they understand. Answer any questions honestly.
• Address any possible problems before the test or procedure.
• Give your child the opportunity to make decisions where appropriate. For example, they can decide which finger to prick to get a blood sample.
• Rehearse the procedure with a toy so your child gets experience with it during play. For example, you could use puppets or dolls to show where a central line might be placed.
• Read books about similar situations. Have your child make up their own stories.

Teenagers

• Explain what will happen and answer any questions honestly. Use diagrams if needed.
• Address any possible problems before the test or procedure.
• Give your teenager the opportunity to make decisions where appropriate.
• Encourage them to bring objects to distract themselves during the procedure, such as CD players, or books.

How can pain be controlled?

There are many things you can do to help control your child’s pain. Because you know your child best, you will know which approaches are the most helpful for your child. In addition, the treatment team will provide medicines to control pain if necessary. Here are some general approaches you can take.

• Be supportive, confident, and honest. Prepare your child for painful procedures. Let them play to express their feelings (supportive methods).
• Distract your child with games, music, stories, videos, or by getting them to think of positive images or experiences (cognitive methods).
• Teach your child breathing and relaxing techniques (behavioural methods).
• Provide comfort by touching your child (physical methods).

Based on your child’s age, here are some specific examples of what you can do when your child is in pain.

Babies (ages 0 to 1)

• Sing to your child or play soothing music.
• Provide a soother for sucking.
• Rock and pat your child rapidly.
• Cuddle your child.
• Talk or engage your child to distract them.
• Give your child a new or favourite toy to distract them.
• Feed your child.

Toddlers (ages 1 to 3)

• Hold and cuddle your child.
• Use favourite songs or music to distract them.
• Give your child their favourite objects for comfort.
• Read stories to your child.
• Get them to blow bubbles.
• Have your child act out a painful procedure afterwards.
• Use positive reinforcement, such as stickers, coupons, praise, and positive comments.

Pre-school children (ages 3 to 6)

• Talk to your child during procedures.
• Stroke or cuddle your child.
• Tell them stories.
• Use favourite songs or music.
• Use distracting objects such as pop-up books or toys with moveable parts.
• Get them to blow bubbles.
• Teach them breathing and relaxing techniques.
• Have your child act out a painful procedure afterwards.
• Use positive reinforcement, such as stickers, coupons, praise, and positive comments.

School-aged children

• Talk to your child during procedures.
• Teach them breathing and relaxing techniques.
• Use distracting objects.
• Use gentle massage.
• Use favourite songs or music.
• Tell them stories or encourage them to tell stories.
• Use positive reinforcement, such as stickers, coupons, praise, and positive comments.

Teenager

• Have a conversation during a procedure.
• Teach them breathing and relaxing techniques.
• Use massage.
• Get them to listen to music, read, or watch TV or videos as distraction.
• Encourage them to bring comfort objects to procedures.
• Use positive reinforcement by praising them after a procedure.

Breathing and relaxing

The simplest form of relaxation is what we call "breathing and blowing." It can be learned even by 3-year-olds and is useful right through adulthood. Mothers may have used a similar technique at the time of the child's birth. Have your child take a deep breath in and blow it out slowly, then repeat this exercise several times. Slow, rhythmic repetition of breathing and blowing helps children relax and gives them some control in situations that may be painful and scary. It is important for your child to learn and practise this exercise before a painful experience. Here are some tips for teaching and practicing the technique:

• Have your child pretend that they are a big balloon and are slowly letting all the air out of the balloon.
• Have your child pretend that there is a birthday cake in front of them with lots and lots of candles; their job is to blow out all the candles very slowly.
• Young children enjoy using bubbles to learn the breathing and blowing technique. Using a bubble wand, blowing slowly will create a stream of bubbles. You can make a game of this by taking a turn first yourself and then encouraging your child to try.
• Hold a tissue in front of your child's face, about 10 to 12 inches away. Then get them to see how long they can keep the tissue blowing in the air as they slowly blow out.