Working In Uncertainty

How to comfort a child in pain

As an expert on uncertainty and the author of two books on how to manage it I often notice new ways that uncertainty affects our lives. Comforting a child in pain is another interesting one. I'm a father of three children, all boys, and when one of my boys comes to me in pain, perhaps crying after an accident playing sport, I want to comfort him. The way I do that has gradually developed over the years and it reflects the uncertainty in the situation. Perhaps you will find it interesting and useful.

Before I go any further I should point out that I'm not a doctor and the following suggestions are not relevant to chronic pain or to pain resulting from serious injuries or illness. It is also not very useful with children who are too young to understand speech. Finally, this is about comforting a child, not reducing the pain, which of course is also a good thing to do if possible.

We all know that a parent should give a hurting child attention, a cuddle, and not try to pretend the pain isn't there. But there's something else, very simple, that we can and should do that will comfort a child quickly.

What pain is

To understand why this technique works we need to understand that pain conveys unreliable information. It tells us that there may be some level of damage to our bodies. Pain is not a very reliable message. Sometimes we feel a lot of pain, such as from a slap to the buttocks, but the damage is nothing more than a reddening of the skin. At other times we can feel little or no pain despite huge damage. When Ronald Reagan was shot in the chest by a 9mm bullet he didn't know it had happened. Driving away in the car later he began to feel sick. A year later, in an interview, Reagan said ‘I had never been shot before except in the movies. Then you always act as though it hurts. Now I know that does not always happen.’

So, when a person experiences pain their sensation is exacerbated by the worry that their body may be damaged in some way.

When a child is hurt he tends to do two things, probably instinctively. A young child will cry, which creates a noise and special appearance (red eyes, wet face, square mouth, wobbling lip) that attracts parental attention. He will also grip the painful body part, if possible. I think the reason for this behaviour may be, in part, an instinctive desire to stem possible bleeding, but it is also true that this can reduce the actual sensation of pain.

‘Show me’

So, the first thing I usually say when one of my boys is crying is ‘Are you hurt?’ (as opposed to just upset emotionally). Having established that there is pain the next step is to say ‘Show me’ and take a careful look at where the pain is coming from. Sometimes they will not remove their hand from the painful area so I have to say ‘I need to check you're ok. Please move your hand. I'm just going to look.’

(Clearly it's not just the child who wants to know if there is damage. As a parent you also want to know.)

The next key message, if true, is ‘There's no blood’ or ‘You're not bleeding.’ Here is where the calming effect usually begins, as uncertainty about possible physical damage is reduced. If there is blood then it is important to explain exactly how much there is, how serious it is, and that the child is going to be ok soon. For example, you could say ‘There is blood but it's only a tiny amount. We just need to clean this and put some cream and a plaster on.’ or ‘There's blood and a cut about 2 cm long. You're not going to die and you're quite safe, but I'm going to drive you down to the hospital so a doctor can take care of it.’

The next step is to check for damage under the skin, such as broken bones. Ask your child to wiggle his fingers or toes, or other limbs so that you can see if there might be a break. Feel around the bones if you know how. Focus so your child knows you are taking him seriously and your information is going to be reliable.

Explain what you can see, especially if your child cannot themselves view the site of the pain. For example, ‘There's no reddening and I don't see any sign of bruising. You're going to be fine very soon.’ or ‘There's some reddening.’ or ‘You can move your fingers and hand easily so I don't think anything is broken there.’

With the initial checks done you can give a proper cuddle then get on with first aid.

Footballers

Occasionally children follow the lead of Premiership footballers and act more hurt than they really are. They may have a tendency to enjoy the attention and milk it for as long as possible.

The approach described above of carefully studying the child's painful body part and reporting your observations and diagnosis, will tend to make this more difficult for them to get away with. It's not just that you know exactly how badly damaged they are; they know you know!

(Happily, my boys do not do this.)

Going to the dentist

Similar principles can be applied to fear of the dentist. Obviously a child, like anyone else, feels that at any moment while the dentist is working he may experience some nasty stab of pain. But, on top of this, he feels discomfort, sometimes pain, while the dentist works, but cannot see what is happening. As far as the child is concerned there could be blood everywhere and bits of severed flesh about to choke him.

Explain that although the child cannot see what is happening the dentist can see very well. The dentist has done this hundreds of times and once the child is lowered into the special chair, with the special bright light, and the mouth is wide open, the dentist can see everything.

Yes, there may be some pain and there may even be a little blood, but the dentist can see and feel what is happening and can be trusted to avoid doing damage.

All the child has to do is keep that mouth open so the dentist can see well, and keep still so the dentist can work safely.

Having a hair cut

Exactly the same applies to getting a hair cut though, fortunately, with an overall lower level of pain! Children are worried that the barber will damage them with the scissors, clippers, or hard comb. They tend to shy away slowly from the barber and need to be repositioned.

Again, part of the problem is that the child cannot see what is happening. Reassure him that the barber can see perfectly and has done it hundreds of times before. All the child has to do is keep still and let the barber get on with it.

(Perhaps I shouldn't mention this, but when I was a teenager a barber actually did stab his scissors into my ear lobe by accident, causing bleeding. He made matters worse by pinching my ear very hard and trying to convince me that nothing had happened. Because he was pinching the ear no blood flowed and of course that prevented clotting. Every time he stopped pinching, the blood immediately flowed again, so the whole ordeal was much longer than it needed to be.)

Promptness and persistence

I don't think it is necessary for children to understand intellectually the logic of what you are doing. They seem to be comforted as soon as you start saying things like ‘There's no blood’. However, you may still need to repeat yourself several times, especially when explaining that a dentist or barber can see clearly what they are doing and will not cause injury.

Checking the level of damage to dispel anxiety is good for the child and for the parent, so it should be a common habit among parents. However, it is easy to waste too much time on cuddling or jump straight into distracting the child from the pain. Don't wait for your child to calm down before taking a look. Just get on with your investigation.

The traditional remedy of ‘kissing it better’ may be as effective as it is in part because it involves taking a very close look at the site of the pain.

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