Pediatrician’s Perspective: Pain – When Bad Things Happen to Good Children

I believe that nothing gives parents more pain than watching their child face pain, especially medical pain. Even relatively small things—shots, bleeding cuts, stitches—give parents (and of course children) a hard time. When more daunting things are happening—surgery, serious illness, serious injury, or hospitalization—most parents are going to be suffering a lot. The child’s pain actually hurts you, his fear frightens you. Your children are the most important things in your life, and they are in peril. No wonder you are hurting. I don’t know many parents who wouldn’t gladly undergo twice the pain their child was facing if it would spare their child.

So it is a cruel irony that the most important gift you can give a hurting or fearful child is your strength and confidence, your absolute certainty that everything will be all right, that they can handle it, that the situation is under control, that you will make sure that they are all right, that you will be with them whenever possible, that the medical personnel have only their best interests at stake, and that they are wonderful and have your complete confidence. No matter what you’re feeling.

Projecting this existential stance is a tall order when you are somewhere on the spectrums of frightened, angry, ambivalent, conflicted, guilty, sick yourself, or whatever. It’s not easy even when you are confident that you are doing the right thing for the right reasons with the right people, simply because it’s upsetting when your child is upset.

Taking Charge of Yourself

To master the support role so vital for the parents of a hurting or frightened child, you need to take charge of your own emotions. You will feel, of course, what you feel, but you don’t have to display those feelings. You cannot be too wounded-acting yourself, and you can’t be too engulfing or too pitying toward the child. Indulging in the expression of your feelings of fear or uncertainty adds tremendously to the burdens that the child feels. Nothing is more frightening to a child than a frightened parent. And your display of fear or anguished pity authorizes his acting out his feelings of fear or desperation, which can easily snowball into panic or at least interfere with whatever needs to be done as expeditiously and carefully as possible. A parent in control also serves to relieve the child of the whole burden of self control. If he is thinking “I can’t do this, I can’t hold still for this, I can’t keep from trying to escape”, the parent is ready to supply the control. “I’ll help you hold still so it will hurt less and so it will be over sooner.” And then firmly though lovingly she contains the child and facilitates the procedure.

When a child sees the confident parent come in, there is such visible easing of the child’s distress. We had a little girl come in with her aunt. She had cut herself deeply in a scary accident, and her mother had not been at home. Of course, she was very upset, and it was almost impossible even to examine her and clean the laceration. Finally, her mother arrived, confident and calming, and the transformation was amazing. She cried more, but she visibly relaxed, and we were able to clean and stitch her wound.

How to Help—Some Suggestions

There are many ways to help a hurting or frightened child; a few are listed here. Some are more helpful in a given situation than others.

Acknowledging—If your child is giving you clear signs of pain or fear, acknowledge what he is experiencing. “I bet that hurts.” “I think anyone would be scared about that.” “I don’t think I’d like that either”. But don’t suggest fear or pain, and don’t undermine your child’s effort to be stoic or to cope with the fear.

Reframing—Try putting a positive spin on something that worries or hurts a child. One little boy was going to have surgery. At the pre-operative appointment, he encountered masked men in green suits (surgeons). He told his mother that he was scared of the men in greens suits. She said, “Oh no. They’re good guys. They will help you. They wear the green suits to keep germs off you.”

Don’t overload—Too much information can overwhelm, and giving it too soon can allow prolonged and unnecessary worry.

No promises—Never bargain, never promise. Some things have to be done, and no one can anticipate all that will happen. Never say that there will be no shots or no pain unless you are at least 1000% sure that there won’t be. “I’m not sure exactly what will happen, but I’ll be with you, and we’ll handle it together.” “We’re going to the right place to get this fixed. You will be all right. We’ll be with you.”

Don’t ask—When faced with a necessary medical event, never burden the child by asking his approval or by giving in to his protests. That gives the child power he knows he shouldn’t have.

Don’t deride—Never belittle your child. Never say “Don’t be a cry baby” or otherwise diminish him. Be low key, positive, and reassuring about his ability to get through this.

Interpret—Keep a running commentary of what is happening. It helps the child prepare himself for the hard parts, and relax (a little) during the less difficult parts. “This is the cold part …this is the tickly part …this is the hurting part.”
Looking to the future—Keep an endpoint is sight. “In 3 minutes/ in an hour/ in a month/ in a year….” During brief procedures, count or count backwards, or sing a song. For longer or repeated matters—like hospitalizations, dressing changes—mark the event or the day off on a calendar or have a small ceremony each time (a ritual chewing of a piece of gum, applying a small sticker to a notebook)

Recapping—Talk about the painful/frightening event after it’s over, praising the child. “Hey, you did it.” “That was rough, wasn’t it? But you made it. I’m proud of you.” Remember, fear is OK, crying is OK. Getting the thing done is all that matters.

With tiny babies and toddlers and non verbal children, talk positively and supportively and give them good physical containment. Positive talk helps them and helps you too, and they will hear and feel the reassurance. And they will learn to understand.

And for the very young or nonverbal, it helps sometimes to keep recurrent painful experiences separated from other experiences. Don’t do painful dressing changes in the same place you change the diapers. If you do, diaper changing will become frightening too.

So …

To help your child get through difficult encounters with fear and pain, model calmness, sureness, and positiveness. Keep your own (very understandable, but counter-productive) fear and pain and pity (for him and for yourself) under tight control. Be quietly optimistic. Be someone to hang onto, the stable and safe place in a frightening world.

If your child is in quicksand, you don’t jump in and sink with him. You offer him a hand and pull him out.