A doctor examining a child in the hospital

How to Manage Pain in Children

Welcome to the intricate world of child-centric pain management. 

Every parent knows the heartache of seeing their child in pain. Yet, what many don’t realize is that pain management for children is not just a smaller version of adult treatments. 

In the bustling heart of Long Island, Long Island Neuroscience Specialists are at the forefront of this evolving science. Let’s dive in.

The unique nature of children’s pain

Children’s experiences of pain are fundamentally different from those of adults, and understanding this distinction is crucial for effective child-centric pain management. 


These differences arise due to a multitude of factors—physiological, psychological, and developmental—that contribute to a child’s unique experience of pain.

Comparing child and adult pain

As adults, we often trivialize the sharp sting of a stubbed toe or the throbbing ache from a headache. However, children’s perception of such pain is frequently heightened.

Their nerve endings are still developing, and their physiological systems are not fully matured. This heightened sensitivity is compounded by their still-developing cognitive and emotional faculties. While an adult may have developed coping mechanisms to deal with discomfort, children may find it overwhelming to navigate the terrain of physical pain.

Additionally, their verbal skills may be limited, making it challenging to articulate the nature or extent of their suffering adequately. They might not even understand that their experience is not “normal,” which makes it even more essential to approach their care with targeted, child-centric strategies.

The spectrum of pain in children

Children’s medical concerns are varied and extensive. From acute conditions like fractures or burns to chronic illnesses such as cancer and hemophilia, the spectrum of diseases they face is wide-ranging. Each condition requires a different pain management approach.

For instance, the intermittent pain from a sickle cell crisis is not the same as the continuous pain experienced in certain types of cancer. Child-centric pain management acknowledges this diversity by customizing treatment plans to cater to each child’s unique needs.

Implementing effective child’s pain management is not just about medication. It also includes educating families, employing psychological strategies like distraction or relaxation techniques, and even using age-appropriate tools like games or storytelling to help children articulate their pain.

An interdisciplinary approach that involves pediatricians, nurses, psychologists, and parents is often the most effective.

Recognizing the distinct nature of children’s pain is the cornerstone for effective pain management in children.

A one-size-fits-all approach may be woefully inadequate; understanding the nuances of a child’s pain experience is key to their well-being and recovery.

Therapist treating a girl's knee

Pain assessment in children

Child-centric pain management places the child’s unique experience and needs at the forefront. Assessing pain in children can be more complex than in adults due to factors like developmental stage, cognitive abilities, and communication skills.


Here are some of the commonly used assessment techniques for child pain management:


  • Faces Pain Scale-Revised (FPS-R): This scale shows a series of faces ranging from smiling (no pain) to grimacing (maximum pain). Children are asked to point to the face that best represents their pain level.
  • Visual Analog Scale (VAS): It’s a line, usually 10 centimeters long, where one end means “no pain” and the other end indicates “worst pain imaginable.” Children are asked to mark on the line where they feel their pain is.
  • Numeric Rating Scale (NRS): Typically used for children above 8 years of age, they are asked to rate their pain on a scale from 0 (no pain) to 10 (worst possible pain).
  • FLACC Scale: This observational pain tool is used for children aged 2 months to 7 years. It stands for Face, Legs, Activity, Cry, and Consolability. Each category is scored from 0-2, which is then summed up to give a score out of 10.
  • Wong-Baker FACES Pain Rating Scale: Similar to FPS-R, it uses facial expressions to represent levels of pain, but it also has accompanying numeric ratings.
  • COMFORT Scale: This behavioral observation scale assesses discomfort in critically ill children, especially those who cannot self-report.
  • Poker Chip Tool: Typically used for children aged 3 to 7. Children are given four poker chips and told each chip represents a “piece of hurt.” They are then asked how many “pieces of hurt” they have.
  • Oucher Scale: This uses photographs of children’s faces, ranging from smiling to crying, to depict pain levels. It also has a numeric counterpart.
  • Non-communicating Children’s Pain Checklist (NCCPC): This is designed for children with cognitive impairments who can’t self-report their pain. It observes various behaviors, such as vocal expressions, facial expressions, and body movements, to assess pain.
  • Pediatric Pain Profile (PPP): Similar to NCCPC, the PPP is designed for children with severe neurological impairment. It charts 20 typical pain behaviors over time.

These assessment techniques can be used individually or in combination, depending on the child’s condition and developmental stage. It’s essential to ensure that the chosen method is age-appropriate and suitable for the child’s cognitive and communication capabilities.

A woman playing with a child to distract him from pain

Child-centric pain therapies

Child-centric pain management therapies focus on the unique needs and experiences of children, ensuring that the approach is tailored, effective, and, most importantly, child-friendly.


Here are some of the most effective ways we can help children cope with pain through these specialized treatments:


Distraction Techniques:

Physical Therapies:

  • Massage: Gentle massages can alleviate muscle tension and provide comfort.
  • Heat and Cold Therapy: Depending on the type of pain, warm or cold packs can be applied to reduce discomfort.
  • Physiotherapy: Tailored exercises and movements designed to strengthen muscles, improve mobility, and alleviate pain.

Cognitive Behavioral Therapy (CBT):

This approach helps children recognize and change negative thought patterns and behaviors that may amplify their pain.



Teaching children to control physiological functions to help manage their pain. For example, they can learn to relax certain muscles to reduce headache intensity.


Mindfulness and Meditation:

Techniques such as deep breathing, guided imagery, and progressive muscle relaxation can be particularly effective for managing pain in children.


Pharmacologic Therapies:

  • Topical Analgesics: Non-invasive creams or gels applied to the skin.
  • Non-opioid Pain Relievers: Over-the-counter pain relievers tailored for children.
  • Opioid Medications: Used sparingly and under strict supervision for more severe pain situations.
  • Adjuvant Medications: Such as antidepressants or anticonvulsants, which can be used to treat certain pain conditions in children.

Patient-Controlled Analgesia (PCA):

Especially for post-operative pain, children can control their pain relief with prescribed limits using a PCA pump.


Acupuncture and Acupressure:

Traditional chinese treatments that can be adapted for children to help alleviate certain types of pain.


Educational Approaches:

Helping children understand their pain can be empowering. Knowledge can reduce fear and anxiety associated with pain.


Providing children with age-appropriate books or interactive apps about pain and its management.


Family Involvement:

Engaging the family in pain management techniques such as creating a comfortable environment, positive reinforcement, or simply being there for emotional support can be extremely beneficial.


  • Support Groups: Meeting other children with similar pain experiences can provide emotional support and reduce feelings of isolation.
  • Dietary Adjustments: Sometimes, pain can be managed or reduced by altering the child’s diet, especially if the pain is linked to conditions like celiac disease or certain food allergies.

Child-centric pain therapies understand the intricacies of a child’s world. The core principle is to blend medical expertise with compassion, ensuring that children not only recover from their ailments but also retain their joy and innocence throughout the healing process.

Young girl suffering headache

Types of pain in children

Children can suffer from various types of pain, each differing in its cause, intensity, and treatment options.

Abdominal Pain:

This type of discomfort is often common in children, ranging from overindulgence in sweets to more serious conditions like celiac disease. Though tummy aches can be common, they warrant careful evaluation to rule out any underlying health issues.

Back pain and headaches:

The contemporary lifestyle, laden with heavy backpacks and extended screen time, has made back pain and headaches increasingly common among children. These types of discomfort may be indicative of poor posture or eye strain and may require lifestyle adjustments.

Myofascial and neuropathic pain:

This category of pain encompasses muscular and nerve pain. Myofascial pain may arise from muscle strains or overuse, while neuropathic pain could be the result of nerve damage. Identification of the specific type of pain is crucial for targeted treatment.

Pelvic pain and primary pain disorder:

These conditions can be complicated and may require specialized, child-focused pain management strategies. Pelvic pain can result from a variety of issues, including gastrointestinal problems or gynecological conditions in older girls. Primary pain disorders, on the other hand, may not have a clear underlying cause and can be challenging to manage.

Post-surgical pain:

Surgery often comes with its set of challenges, including post-operative pain. Effective pain management techniques can help alleviate discomfort and speed up the recovery process.

Children’s pain can be multifaceted and may require a multi-disciplinary approach for diagnosis and treatment. Recognizing the type of pain is often the first step towards providing effective relief.

Understanding pain medications for children: a child-centric approach

Administering pain medications to children is a sensitive matter requiring special attention to dosage, timing, and potential side effects. 


A Child-centric Pain Management approach focuses on tailoring medication plans specifically for the individual child, rather than simply scaling down adult doses. 


This ensures that the child’s unique physiology and needs are taken into account, allowing for effective and safe pain relief.


Pediatric Opioids: 

Opioids like morphine, oxycodone, and fentanyl are powerful agents for pain relief but they come with risks such as respiratory depression, dependency, and other side effects. 


When considering opioids for children, medical professionals weigh multiple factors including the child’s age, weight, overall health, and the type of pain they are experiencing. 


The objective is to use the minimum effective dose for the shortest possible duration. 


Sometimes, opioid medications are used in combination with other non-opioid analgesics to enhance pain relief while minimizing opioid-related side effects.


Narcotic Pain Medications for Kids: 

Narcotic medications are another category often used for more severe types of pain like post-surgical discomfort or acute pain from injuries. 


While narcotics are effective, their potential for abuse and adverse effects like constipation or nausea cannot be overlooked. The key to using narcotic medications safely in children is stringent monitoring by healthcare providers. 


Frequent assessments are essential to gauge the medication’s effectiveness and to adjust dosages or discontinue use if necessary.

Both categories of pain medications have the potential to significantly improve a child’s quality of life by alleviating pain effectively.


It’s imperative for caregivers and healthcare providers to engage in open communication about the child’s pain levels and any observed side effects, as this will inform ongoing treatment decisions.


Always consult with a pediatrician or a pediatric pain specialist when considering pain medication for children.

Interventions for children with chronic pain

Persistent pain can be a bully, but with the right strategies, kids can stand tall.

  • Individualized Treatment: Two children, same age, might still need different treatments. child-centric pain management is all about tailoring the approach to each child’s unique needs.

In conclusion

The groundbreaking approach of child-centric pain management is gaining momentum. 


Navigating the complexities of children’s pain can be challenging, but by harnessing the right strategies and methodologies, we inch closer to a future where no child has to endure unnecessary pain.

If you’re a parent, caregiver, or just someone interested in ensuring our children’s well-being, dive deeper. 


Explore the world of child-centric pain management with Long Island Neuroscience Specialists. Because every child deserves a pain-free future.