Just like adults, kids have different pain thresholds because they also respond based on learned experience and how everyone around them responds when they hurt themselves. These experiences and responses gives them a pain calibration and one of the reasons you see mums and dads giving a sore knee a rub and a kiss and encouraging the child to run back to play. As a health practitioner, you need to work within this framework of learned response.
The child who presents with calcaneal apophysitis and has only ever had a skinned knee may respond very differently to the child who also has juvenile idiopathic arthritis or has recently had broken an arm or leg and remembers the pain associated with it. Similarly, the child with a disability may also under or over report pain based on their ability to comprehend but also process pain responses.
Ultimately, pain is pain. It is subjective, real and individual. We need to take it seriously in kids and help the child work through it. We need to also be very honest when we are doing something that may hurt, like give a needle. We need to talk to them age appropriately, like before a needle, “Yes, this may hurt but only for a moment. If you count to 5 with me, it will be over before we get to 5”. If you ask a reference point on what pain they have experienced before you can also give them some indicator if it may be more, less or similar. We need to give them honest answers when they ask about something hurting.
Similarly if you use honest language about the pain they are experiencing when playing on the field. You tell them that often your body give different responses to pain. Sometimes it is to tell them to stop something because of danger, like when you burn your finger on something hot and you pull your finger away and not do it again. Sometimes you hurt because you are doing something too much or in a way that your body could do better. So stretching, exercises, different footwear or orthotics can help the body work in a better way so they can keep doing it.
In the absence of a serious condition or injury, I have rarely seen any benefit from telling a child to stop what they are doing. They hate it (though the parents might enjoy a sport break), they miss out, they decondition and sometimes they never go back. Instead, I work with them to slow down a little, modify something or do sometimes a little different. Even talk about best case/worst case of playing through it. Really, what is the worse case of something like calcaneal apophysitis, they limp for a while? In the absence of a stress fracture, they are better the next day, why slow or stop? They can have time out breaks during the sport, perhaps even switch sports to something that is less likely to have repeat problems. A good example of needing to seriously change sport is the hypermobile child and trampolining…..worst combination ever!
Ultimately, kids get pain. We can learn a lot from how chronic pain is managed in adults. There are some great Ted talks and other blogs on pain:
https://www.youtube.com/watch?v=gwd-wLdIHjs
https://thesports.physio/2017/06/09/physios-are-too-soft/
However you need to put this into the context of the child who may never experienced it before. You could be responsible for increasing their pain perception. You also need to put pain in the context of the health of the child. Some children live everyday with pain. How we interact with kids, our reactions and our language will go a long way to how they process this pain and set their individual pain threshold.
ChildrensPodiatry.Melbourne © 2016