A 5-year-old complains of a stomachache before school.

Her mother pats her on the back and says, “I’m sorry you’re not feeling well, but we’re late. Let’s get moving!”

A 10-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 14-year-old girl tells her pediatrician she has been having headaches at least twice a week. “That’s probably just stress-related,” he says.

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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 word of encouragement, or a bandage often does the trick. But how do you know whether you have truly addressed the problem? What effect does a painful experience—whether a needle poke or a major bone break—have on a child?

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

By the latest estimates, some 50 million American adults endure chronic pain (generally defined as pain that persists for more than 12 weeks). But adults aren’t the only ones suffering: An estimated 5% of kids in the U.S. experience moderate to severe chronic pain, costing about $19.5 billion annually.

Why is it so hard for patients to find appropriate help for their pain? For starters, unless they specialize in pain, most medical students receive only about nine hours of education in pain management. Thus for many clinicians, pain management means prescription of pain relievers. In 2015, government agencies, led by the National Institutes of Health and the Department of Health and Human Services, unveiled the National Pain Strategy, which defines chronic pain as a disease in its own right and provides a comprehensive approach for dealing with it in adults. However, children’s pain is not addressed in the plan.

Pediatric pain is overlooked not only on a national level but also on an individual level. Even when medical professionals know that pain control is needed, they are frequently hesitant to give strong pain medications to children for fear of dangerous side effects, damage to developing brains, and opioid addiction. (Research has found these concerns to be largely unwarranted when it comes to children.) When pain control is subpar, many physicians rationalize it by telling themselves that babies and children won’t ultimately remember the pain. Evidence shows, however, that while babies and children may not consciously remember painful experiences, their nervous systems will. Research has found that early exposures to pain—and early responses to those episodes by clinicians and parents—can shape a child’s neural pathways.

Fortunately, there are pain researchers and clinicians who have developed strategies to treat pediatric pain. Over the past 20 to 30 years, these experts have dedicated their careers to furthering our understanding of pain in children. Parents and other caregivers can also play a major role in alleviating children’s discomfort and advocating for appropriate treatments. Solving our nation’s chronic pain epidemic starts with acknowledging pain and responding to it appropriately.

How to assess your kid’s pain

Each of these tools can bring you closer to understanding what your child is experiencing.

Look at their movements

The way babies and children move can tell us a lot about how they’re feeling, particularly if we can also hear their nonverbal sounds, such as cries. Specific facial expressions and body movements reliably indicate pain: flailing arms, clenched fists, kicking legs, a furrowed brow, eyes that are squeezed shut, and an upper lip raised in a grimace. Parents and clinicians can also get a sense of the severity of babies’ pain by noting their activity level, cries, and ability to be consoled.

When Children Feel Pain: From Everyday Aches to Chronic Conditions

When Children Feel Pain: From Everyday Aches to Chronic Conditions

Consider physiological measures

Still, observing a baby’s behavior is a subjective assessment. To get beyond this, researchers have begun to take into account physiological signals such as heart rate, blood pressure, and electroencephalogram (EEG) brain monitoring, all of which are objective measures that don’t rely on human observation. These techniques are most often used in neonatal intensive care units (NICUs) and in other hospital settings where patients may be unable to express their pain verbally or nonverbally.

Ask the right things

Once children can speak and express themselves, ask them many questions: When did they start to notice the pain? How did the pain start? How frequent is it? What patterns are there (if any) related to when it occurs? What kinds of words would they use to describe it—would they say it is burning, achy, tense, stabbing? How much does it interfere with normal life activities? How bothersome is the pain?

Track pain over time

Part of a child’s treatment may involve their keeping track of pain using a daily pain diary in which they note when pain is felt, how much it hurts, and what type of pain it is. Though clinicians discourage kids with chronic pain from focusing too much on their discomfort, daily diaries can be very useful to patients and doctors in trying to figure out which treatments are working best, which activities are triggering pain, and the influence of different factors like stress and sleep on how the child feels. Smartphones offer convenient ways for children and teenagers to share their pain experiences with medical providers.

Adapted from when Children Feel Pain: From Everyday Aches to Chronic Conditions by Rachel Rabkin Peachman and Anna C. Wilson, published by Harvard University Press. Copyright © 2022 by the President and Fellows of Harvard College. All rights reserved.