Rachel Rabkin Peachman - When Children Feel Pain

When Children Feel Pain

From Everyday Aches to Chronic Conditions

Rachel Rabkin Peachman and Anna C. Wilson

Cambridge, Massachusetts, & London, England 2022

Copyright 2022 by the President and Fellows of Harvard College

All rights reserved

Jacket design: Tim Jones

Jacket art: Westend61, Getty Images

978-0-674-18502-9 (cloth)

978-0-674-28728-0 (EPUB)

978-0-674-28727-3 (PDF)

The Library of Congress has cataloged the printed edition as follows:

Names: Peachman, Rachel Rabkin, author. | Wilson, Anna C., author.

Title: When children feel pain : from everyday aches to chronic conditions / Rachel Rabkin Peachman and Anna C. Wilson.

Description: Cambridge, Massachusetts : Harvard University Press, 2022. | Includes bibliographical references and index.

Identifiers: LCCN 2022001785

Subjects: LCSH: Pain in children. | PainTreatment. | PainPsychological aspects.

Classification: LCC RJ365 .P42 2022 | DDC 618.92/0472dc23/eng/20220223

LC record available at https://lccn.loc.gov/2022001785

To my parents, Elizabeth and Eric Rabkin

Rachel

To my parents, Philip and Mary Long

Anna

1. The long-term payoffs of addressing short-term pain
2. Demystifying the neurobiology of this fiery signal
3. A look back at the historical lack of pediatric pain management
4. Easing the sting of shots
5. Even when wounds are not visible, they can leave their marks
6. How to prepare for these, and how kids remember them
7. The reasons and the relief for a classic childhood complaint
8. Management of frequent headacheswhich should never be ignored
9. The rise of sports injuriesand how to avoid sidelining young athletes
10. When the nervous system goes awryand how to correct course
11. Multidisciplinary treatments for lessening childrens suffering
12. The power that parents have to affect a childs response to pain
13. When stigma and bias lead to isolation and depression, social support can help
14. Preventing chronic pain in the next generation

Unless otherwise noted in the endnotes, direct quotes in this book are taken from our own interviews and conversations with researchers and families. Quotes pulled from other published works or public talks are referenced as such.

To protect the privacy of the children and parents, we use only their first names in most instances, and in some cases use pseudonyms. If a full name is given, that is the persons actual name.

We are eternally grateful to the numerous scientists, clinicians, and families who shared their knowledge and experiences with us as we worked on this book. Not every individual who spoke with us is directly mentioned within these pages, but each influenced our thinking and we could not have produced this work without them. We thank them all wholeheartedly for their generosity, time, and insights.

The long-term payoffs of addressing short-term pain

A six-month-old is lying on his back on an exam table in a pediatricians office. There, there, says the nurse, this will only sting for a second! The baby boy reaches out for his mother, on the other side of the room, and shrieks when the nurse injects a vaccination into his thigh.

A five-year-old complains of a stomachache before school one morning. Her mother pats her on the back and says, Im sorry youre not feeling well, but were going to be late. Lets get moving!

A ten-year-old and her father leave the orthopedist after a long day in the emergency department. She has a brand-new cast on one arm but walks out with no instructions on how to manage the throbbing ache she feels.

A fourteen-year-old girl tells her pediatrician that she has been having headaches after school at least twice a week. Thats probably just stress-related, he says as he peers into her ear canal. How are your classes going?

An eighteen-year-old stumbles on the soccer field and clutches his ankle. Walk it off, yells his coach. Get back out there!

At first glance, these episodes dont seem to warrant a whole lot of concern. Kids get hurt and experience pain all the time, and they usually recover just fine, right? A sympathetic pat on the back, a well-meaning shout of encouragement, or a Band-Aid often does the trick. But how would you know if you had truly addressed the problem? What effect do painful experienceswhether a little needle poke or a major breakhave on a child?

Many adults have no idea. In fact, most peopleincluding many parents, doctors, and psychologistsdo not realize what pain can do to a childs developing nervous system in the short term or the long term. Few are aware that many children experience recurrent or chronic pain that can severely disrupt their lives and continue into adulthood.

The vignettes above are typical examples of how childrens pain is often dismissed, minimized, and flat-out ignored. Those instances are not anomalies. Episodes of under-recognized pain in children unfold across the country, every day, in homes, medical settings, and playgrounds, among other places. This is not because of a lack of love for these children. It may not even be because there is a lack of access to medical care (though sometimes that is a factor). It is because painespecially pain in childrenis poorly understood. And when pain is misunderstood, it gets sidelined and mismanaged, and can cause far-reaching and lasting damage.

Wed like to change that. Anna (a pediatric pain psychologist) and Rachel (a health and science journalist with a personal history of chronic pain) joined forces on this book to make clear that childrens early experiences with pain matter deeply and can shape future perception of pain and overall development. But our message is not one of doom and gloom. On the contrary, we will demonstrate that adults can do so much morefor the children in their lives and even for themselvesthan sit idly by. Whether you are a parent, a grandparent, a medical professional, a teacher, or anyone else who cares for children, you have the opportunity to affect how children respond to and cope with pain, and your influence now can help them throughout their lives. This book will give you the tools to do so and point you to resources that will make managing childrens pain a priority. The first step is to acknowledge the need for better pain management. The next steps will become clear as you read further, and we hope you will be inspired to take them.

In recent years, the medical community, policy makers, and news media have begun to acknowledge and address the severity of our countrys adult pain epidemic. By the latest estimates, some seventy million American adults endure chronic pain (generally defined as pain that persists for more than twelve weeks), which means it affects more people than diabetes, heart disease, and cancer combined. In addition to the enormous physical and emotional suffering that chronic pain causes, it costs the United States over $500 billion dollars in lost productivity and medical treatments each year.