Classic Signs of Pain in Babies & Toddlers
Your child's verbal and physical cues can be sneaky ways to determine if something is bothering him (and he's not just pre-naptime cranky). Check out these classic signs of baby and toddler pain.
Crying and Irritability
If your baby wails when he’s touched or moved and he’s hard to console once crying, there’s probably more at play than a need for a fresh diaper or immediate feeding.
Cries that are high-pitched or unvarying in pitch can be a sign of distress. Long, shrill, faint crying without regular rhythm has been described in malnourished babies. Of course, individual babies’ cries are as different as fingerprints, and absolute interpretations of any type of infant cry may not be applicable to your baby.
Learn more about decoding Baby’s cries here.
Obvious Facial Distress
When you notice Baby grimacing, clenching her eyes tight, stretching her mouth, or furrowing the two skin folds that run from each side of the nose to the corners of the mouth (called the nasolabial fold), there’s something bothering her tiny body.
Loss of Appetite
Your baby usually feeds on schedule … and now she turns away during nursing sessions. While periods of feeding variability are normal, a trend of poorer feeding over time may signal something more than just an off day. In some cases, a loss of appetite may signify throat pain or chronic abdominal pain.
Because you pick up and tote around your child every day, it may be hard to notice a change in her weight unless it’s especially drastic.
But if you notice her clothes aren’t fitting as they usually should or those usual chubby rolls are looking a bit wasted and saggy, consult your pediatrician: Weight loss can be a sign of chronic pain possibly related to bowel inflammation, reflux disease, gastritis, or food allergy or intolerance. In severe cases, weight loss could even signal water on the brain (hydrocephalus), lead poisoning, or leukemia.
If your baby seems to be back-bending his spine more than his typical stretches require and he seems uncomfortable during this activity, this may be a sign of pain.
Take note of when this happens and consult Baby’s doctor: Arching can be a sign of reflux disease.
While rapid, uncontrollable shaking is most often associated with seizures related to epilepsy, these movements may be the result of Sandifer’s Syndrome, a condition associated with children with reflux.
High fevers, too, may cause seizures in some babies. Learn more about febrile seizures here.
If your usually interactive baby suddenly becomes unusually unresponsive or sleepy, or seems to lack interest in her surroundings when she is normally very curious, this may be a sign of pain or an underlying medical issue.
Intussusception, a condition in which part of the intestine slides (or telescopes) into another part of the intestines, may present as periods of screaming followed by extreme lethargy. Lethargy can also be a sign of ear infection or even meningitis, or it can just be associated with fever due to a simple viral infection.
Please keep in mind, “lethargy” is a dirty word in pediatrics since lethargic babies are usually the most worrisome to a doctor. A tiny proportion of these children are seriously ill, and really, some young infants just “shut down” when they are overstimulated. (How many infants have you seen who sleep through an entire holiday party?)
Shivering or Sweating
Coupled with a pallor (loss of color) and a high pulse rate (which parents may even be able to feel at Baby’s wrist, neck or elbow), sweating and shivering can be objective signs of a child’s pain.
If they’re associated with a fever, there are simple ways to make Baby more comfortable: Read about fever treatment here. If there’s no fever associated with the shaking or sweating, consult your pediatrician.
Changes in Muscle Tone
You know Baby’s usual cries, moods, and schedules, but muscle tone (the baseline tenseness or floppiness of Baby’s muscles) can also be an important signal that something’s wrong.
A stiff, arching, tense child may be telling you something hurts. This is the same concept as when an adult has a toothache and gets a subsequent muscle tension headache.
On the other hand, a floppy, flaccid infant may be sending warning signals as well. Babies who are too exhausted to maintain normal tone—e.g., those who’re lacking head control, unable to sit up, have posture like a rag doll—may be telling you they are in pain. Consult your child’s pediatrician if you notice this change.
Sudden Change in Ability
If your little one suddenly stops walking or feeding herself, or is soiling his pants after a long, successful potty-training stint, this may be sign for concern. A regression of development can mean a figurative cry for help. It may mean your child is working so hard at pain control that he has little energy left for typical motor milestone acquisition.
Decreased Playing or Playfulness
For kids who can’t yet explain how they’re feeling, let their play habits be a window. So many times I hear in the office that a child “just doesn’t usually sit around like this.” Then we find out the reason: He is uncomfortable!
If your normally bouncy, fun-loving toddler is suddenly sullen or depressed, consider that something physical might be interrupting her routine and take note of any other signs she is exhibiting.
Kids may have a range of developmental verbalizations (“ouchy!” “boo-boo,” “It hurts!”) to express what’sbothering them. The where may be hard to track at this point, but at least parents can evaluate what their child has done, eaten, etc. recently to get clued in.
Complaints below the True Source of Pain
Toddlers may complain of knee pain when there is really a hip issue—always strip down a toddler and look a joint above and a joint below the complaint.
Some toddlers may even complain of hip or leg pain as a presenting sign of kidney disease, or very rarely (thankfully!) abdominal tumor or leukemia.
Pointing to the Actual Source of Pain
What a relief when your child finally can help you locate what’s bugging her, right? Well, a toddler pointing to a source of pain can still be tricky: So many times parents bring a child in to be seen because of ear pulling (or pointing to an ear), for example, only to find the ear totally normal on exam.
But a child who is pointing to a painful spot usually raises your index of suspicion and warrants further evaluation. Trust your parental instincts if you think something is wrong and contact your child’s physician.
Photo Credit: Shown: Partial
Can Use a Measurement Scale to Indicate Pain
You sometimes see these in doctor’s exam rooms (and they’re especially common in children’s hospitals): Charts with a range of smiley cartoon faces or actual kid faces, indicating degrees of pain. Some doctors (and families) use “The Oucher” scale or non-choking poker chips that correspond to levels of pain. Kids are able to use the simplest of these measurement scales around age two.
Dealing with Infant & Toddler Discomfort
If you believe your child is experiencing pain that you can’t locate or doesn’t dissipate after an adequate dose of acetaminophen and 45 minutes, call the pediatrician and explain your child’s symptoms. He may have advice to keep your child comfortable until he can see him in the office, or may advise seeking emergency treatment.
New parents worry every time their baby sneezes or has a rash, but nearly every baby will experience at least one of the following medical conditions during his or her first year of life. Luckily for parents, these conditions are usually easy to treat. Review gallery
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