Pain management (acute) - children

Pain can affect a child’s development, so it should always be managed. Common causes of pain in children include injury, illness, medical procedures such as vaccinations or surgery, and normal childhood events such as teething.

If you think your child is in pain, always see your doctor for diagnosis and treatment. It will not always be necessary to give your child a pain medicine, because many other approaches can help relieve a child’s pain.

Pain medicines for children#

If a pain medicine is needed, always read the label and follow the dosage instructions exactly. For mild pain, such as discomfort from a new tooth, an over-the-counter children’s paracetamol or ibuprofen may help. These are often used together with non-medicine strategies.

In more serious cases, such as pain from a broken bone, a doctor may need to prescribe stronger medicines.

How to measure pain in children#

Measuring a child’s pain level can be difficult, particularly in babies and very young children who cannot tell you how they feel. The following can help.

Watch how the child responds to the pain#

They may cry, moan or groan, grimace or writhe, or cradle and protect a sore body part from accidental bumps.

Notice how the child looks#

They may be flushed and sweaty, or look pale and tired.

Notice how the child behaves#

They may be quieter than usual or more irritable, stop playing, lose their appetite, become listless, or return to behaviours they have outgrown, such as thumb sucking.

Listen to the child#

If they are old enough, they may be able to use words or drawings to describe how much it hurts. A child aged 7 or older can often rate their pain on a scale from 0 to 10, where 0 is “no pain” and 10 is the worst pain imaginable.

A doctor can also check for physical signs of pain, such as heart rate, blood pressure and blood oxygen levels.

Trust your instincts#

No one knows your child better than you do.

Non-medicine ways to relieve a child’s pain#

Non-medicine techniques fall into three broad groups: environmental, physical and distraction techniques.

Environmental techniques#

• Swaddle or wrap babies.
• Show the child that you are taking their pain seriously.
• Tell them what is happening using words they can understand. Fear and anxiety are known to increase the perception of pain.
• Reassure them that their pain will be managed and that the treatment (such as an injection) will be less painful than the pain itself.
• Allow your child some control over the situation. For example, an older child could choose whether to take their medicine as a syrup or a tablet, and which flavour of syrup they prefer.

Physical techniques#

• Give plenty of cuddles.
• If a child is teething, gently massaging the gum with a clean finger or offering a teething ring to chew may ease the discomfort.
• Icepacks or heat treatments can reduce some types of pain. Ask your doctor for advice on what is suitable.

Distraction techniques#

• Distract your child with games, books or favourite television shows.
• A health professional may give a baby younger than 12 months a sucrose solution to help with painful procedures.
• If your baby is younger than 6 months and you are breastfeeding, feed them during a painful procedure such as a vaccination.

Using over-the-counter pain medicines safely#

Giving more than the recommended dose can make side effects more likely or more severe, and these side effects can be dangerous. For example, too much paracetamol can cause liver damage, while too much ibuprofen can increase the risk of stomach problems. Always give the dose written on the bottle or pack, based on your child’s weight.

Unless a doctor has advised otherwise, do not give aspirin to children under 16 years of age. Aspirin use in children is linked to an increased risk of Reye’s syndrome, a potentially fatal condition that involves damage to the liver and brain.

Always check the active ingredient so you do not accidentally double up with another medicine that contains the same ingredient. For example, some cold and flu products also contain pain medicines.

Use a medicine formulated for the child’s age. Pain medicines can come as liquids, drops, suspensions, tablets or suppositories.

Follow the dosage recommendations exactly#

• Work out the right dose using the child’s weight. Never guess the amount or try to adapt it from adult dosing instructions.
• If a child is heavy or underweight for their age, check the correct dose with a doctor or pharmacist first.
• Do not assume that a larger dose will give better pain relief. It may increase the risk of side effects or harm without reducing pain any further.
• If your child is in a lot of pain, seek immediate medical attention.
• Use an oral syringe or the measuring device that comes with the medicine. Never use a kitchen spoon, which is not an accurate way to measure a dose.
• Keep a record of all medicines given: the date, time, strength of medicine, child’s weight, exact dose given and a running total for the day.

When measuring and giving a child’s dose, ask yourself: What is the active ingredient? Have I calculated the right dose based on the child’s weight and the strength of the medicine? What is the safest, most appropriate device for measuring it? How do I measure and give the dose accurately? Have I recorded what, when and how much was given?

If your child has a fever#

A mild fever is not usually dangerous and can help the body fight infection, so it does not always need treatment with medicine. Always see your doctor if you are concerned about your child’s health, if your baby is under 3 months of age, or if pain persists.

Paracetamol#

Paracetamol is available over the counter and has been used safely for many years to relieve pain in children. It is not recommended for babies under one month.

There is only a small difference between the maximum daily dose of paracetamol and an overdose, which can cause liver damage. Large amounts are very dangerous, but the effects often do not show until about 2 to 3 days after the medicine is taken. Treatment for a possible overdose must be started early, before the effects begin, to be effective. Always seek treatment immediately if you think your child has had too much paracetamol, even if your child seems quite well.

Non-steroidal anti-inflammatory drugs (NSAIDs)#

NSAIDs are medicines that reduce pain and fever as well as inflammation (redness and swelling). Ibuprofen is an NSAID that is available over the counter. Give the dose written on the bottle or pack based on your child’s weight, as too much ibuprofen can also cause serious side effects. Ibuprofen is not recommended for babies under 3 months.

Prescription pain medicines#

Other pain medicines available on prescription can be used to treat moderate to severe pain. Some examples include morphine and oxycodone.

Some parents fear that their child could become addicted to certain prescription pain medicines, but addiction or dependence in children is extremely rare. A short course of opioid medicine may have other side effects, but it is unlikely to cause dependence in children when given according to a doctor’s instructions.

Unhelpful pain-management strategies#

Some approaches only increase a child’s fear and anxiety and are best avoided. For example, avoid false reassurance, such as telling a child that a procedure like an injection will not hurt when it will. Research shows that a person who expects the worst tends to perceive their pain as more intense.

Key points#

• Common causes of pain in children include injury, illness, medical procedures and normal events such as teething. Always see your doctor for diagnosis and treatment.
• Many treatments, including non-medicine techniques, can help relieve a child’s pain.
• Environmental, physical and distraction techniques can all reduce a child’s pain and distress.
• Icepacks or heat treatments can reduce some types of pain.
• Always work out the dose by weight and follow the label exactly. A larger dose increases the risk of harm without giving better pain relief.

Where to get help#