Pain in children should always be managed. Causes of pain in children include injury, disease, medical interventions such as vaccinations or surgery and normal childhood events such as teething. If you think your child is in pain, always see your registered medical doctor (GP) for diagnosis and treatment.
It may not be necessary to give your child medication to relieve their pain. Many non-drug treatments are available that can be useful to help a child’s pain. If a pain-relieving medicine is needed, take care to always read the medicine labels and packaging and follow dosage instructions exactly as directed.
In mild cases, such as pain from a new tooth (eruption), over-the-counter products such as child formulations of paracetamol or ibuprofen may be used. In more serious cases (such as pain from a broken bone), a doctor may need to prescribe stronger medicines to manage the pain, often in combination with another pain reliever.
How to measure pain in children
Measuring a child’s degree of pain can be tricky, particularly in babies and very young children who have no direct way to communicate.
- See how the child responds to the pain – they may cry, moan and groan, grimace, writhe, cradle the sore body part or protect it from accidental bumps.
- See how the child looks – for example, they may be flushed and sweaty, or pale and drawn.
- See how the child behaves – for example, they may be quieter than usual or more irritable, stop playing, lose their appetite, be listless or regress to behaviours they have outgrown such as thumb sucking.
- Listen to the child – if old enough, they may use words or drawings to communicate the severity of the pain.
- Trust your parental instincts – no one knows your child better than you do.
- Measure physical reactions – the doctor can check for physical signs of pain such as heart rate, blood pressure and blood oxygen levels.
Non-opioid pain-relieving medications
Non-opioid medicines are used to treat mild to moderate pain. Some examples of non-opioid medicines include:
- Paracetamol (available over the counter)
- Non-steroidal anti-inflammatory drugs (NSAIDs) – medicines that reduce inflammation (redness and swelling), such as ibuprofen (available over the counter)
- Local anaesthesia block – an injection that a doctor may give directly at the injured area.
Opioid pain-relieving medications
Opioid medicines are used to treat moderate to severe pain. Some examples include:
Most opioid medicines should only be given to children under a doctor’s instructions. Your pharmacist can advise you if you need to see a doctor for a prescription.
Some parents may fear that their child could become addicted to opioid medicines, but addiction or dependence in children is extremely rare. A short-term 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.
Safe use of over-the-counter pain relievers
Paracetamol and ibuprofen work equally well to relieve pain in children and cause few side effects when used correctly for a short period of time. Giving more than the recommended dose may make side effects more likely or more severe, and can be dangerous. For example, giving too much paracetamol can cause liver damage, while too much ibuprofen may increase the risk of stomach problems.
Unless a doctor has advised otherwise, do not give aspirin to children under 12 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. Check with your doctor first before giving over-the-counter medicines that contain codeine.
Check the dose and active ingredient
When measuring and administering a child’s dose of medicine, ask yourself:
- What is the active ingredient in the medicine?
- Have I calculated the right dose based on the child’s weight and strength of the medicine?
- What is the safest and most appropriate device for measuring the child’s dose?
- How do I measure and give the dose accurately?
- Have I recorded what, when and how much medicine was given?
Pain management tips for parents and carers
Parents and carers can follow some simple steps to ensure they give over-the-counter pain-relieving medicines to children safely and effectively. These include:
Always see your doctor if you are concerned about your child’s health or if your baby is under three months of age.
- Always check the active ingredient in a medicine to ensure you’re not doubling up with another medicine that contains the same active ingredient.
- Use a medicine that is specifically formulated for the child’s age.
- Follow the dosage recommendations exactly as directed.
- Work out the right dose using the child’s weight. Never guess the amount to give or try to figure it out from adult dosing instructions.
- If a child is heavy or underweight for their age, check the right dose to give with a doctor or pharmacist first.
- Do not think that increasing the dose will give your child more effective pain relief – it may increase their risk of side effects or cause them harm. If your child is in a lot of pain, you should seek immediate medical attention.
- Use an oral syringe or the measuring device that comes with the medicine to give the dose. Never use a kitchen spoon – this is not an accurate way to measure the right dose.
- Keep a record of all medicines given, who by and for what reason. Include the date, time, strength of medicine, child’s weight, exact dose given and a tally of the daily total.
- If your child has a fever, this does not necessarily mean they will need medication. A mild fever is not usually dangerous and can help fight infection. Pain-relieving medicines should be given if your child is in pain, but may not be necessary for fever alone.
Managing different levels of pain
A combination of medicines may be more effective in managing moderate to severe pain than a single medicine. Ask your doctor or other health professional to explain your child’s medicine schedule.
Other pain-management strategies
Many non-drug treatments can be used to relieve a child’s pain. Suggestions for parents include:
- Give plenty of cuddles and attention.
- 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 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, they could decide whether to take their pain medication as a syrup or tablets, and ask what flavour of syrup they prefer.
- Distract your child with games, books or favourite television shows.
- If a child is teething, simple measures such as gently massaging the gum with a clean finger or chewing on a teething ring may help to relieve discomfort.
- Icepacks or heat treatments can reduce pain. Ask your doctor for advice.
Unhelpful pain-management strategies
Some approaches only increase a child’s fear and anxiety. Unhelpful strategies that are best avoided include:
- Fake reassurance – don’t tell them that a procedure, such as an injection, won’t hurt when you know it will
- Belittling – don’t ridicule your child for acting ‘like a baby’ in the hope they will respond with bravery
- Being anxious yourself – don’t fixate on their pain or scare them with gruesome talk about future suffering they may have. Research shows that a person who expects the worst will perceive their pain as more painful.
Where to get help
- Your doctor
- Maternal and child health nurse
- Maternal and Child Health Line (24 hours) Tel. 132 229
- NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
- Medicines Line Tel. 1300 633 424
- Adverse Medicine Events Line Tel. 1300 134 237
- Austin Health Acute Pain Service Tel. (03) 9496 3485
Things to remember
- Always see your doctor for diagnosis and treatment if you think your child is in pain.
- Non-drug strategies can be very effective for relieving mild pain.
- If using an over-the-counter medicine, choose one specifically formulated for your child’s age. Follow the dosage recommendations exactly as directed and use the child’s weight to calculate the right dose.
- Measure the dose accurately with an oral syringe or the device that comes with the medicine – never a kitchen spoon.
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