When working as a clinician that specializes in chronic pain, it doesn't take long before patients begin to ask you questions about their children:
"The doctor says my child has growing pains, but do you think they could have fibromyalgia like I do? How young can I have my child tested?"
"My little girl's knees hurt all the time, is it normal that I have to give my 5 year old Motrin this often?"
"My son's teacher thinks he's faking it to get out of doing things at school, but I had headaches as a kid too. How do I manage to keep him in school, but still take his headaches seriously?"
"My child has Ehlers Danlos like me, is it ok for her to do gymnastics? She loves it, but I worry I should I put her in a different sport."
While the questions that arise when raising children seem endless, and all parents have a hard job, raising kids with chronic pain presents some unique challenges. Like most parents, you probably want to correct the wrongs that you suffered from as a child and learn from your parents' mistakes. You most likely want to protect your child, and for them to grow up to live successful and happy lives. So how do you walk the tight rope of helping your child succeed while not ignoring their illness? (See: Helping Kids With Chronic Pain Grow Into Successful Adults) How do you know when to make your child a doctor's appointment and when to wait it out?
Here are a few rules for when it is time to see a specialist:
If your child is avoiding activities they usually enjoy doing.
If your child is waking up with pain at night.
If your child's pain is accompanied by other symptoms such as fevers, joint swelling, rashes, fainting.
If your child's pain is weather dependent and comes with the cold, or a drop in the barometric pressure before a storm.
If your child has been complaining about pain for more than 3 months.
If your gut tells you something isn't right.
Even more so than adults, children will generally ignore pain to engage in activities they enjoy. If your child only develops headaches in math class and they don't like math, it's different than if your child has a headache that keeps them from going out to play at recess. While your child's pain may still be real even if they notice it only during math class, it is definitely worthy of your attention if it's limiting their ability to participate in activities they enjoy. Pain that is impacting your child's quality of life is worth a doctor's appointment.
Waking from sleep to complain about pain is not typical in children. If you are a parent who has chronic pain, this might surprise you, because you may have woken up with pain yourself as a child and therefore don't even realize that it is not something children typically do. For parents who didn't experience pain at night as children themselves, this behavior in children can be frustrating. Most parents are tired themselves, and don't want to be woken up at 2am to complaints from their children on a regular basis.
While some children who complain of pain are accused of attention seeking, this is highly unlikely if your child is waking up at night. As an adult, you wouldn't naturally wake up in the middle of the night without an alarm, and then go complain to someone about pain because you wanted attention. A child wouldn't do that either. Pain at night that is significant enough to wake your child is significant enough to make a doctor's appointment.
Pain that comes with other symptoms that are more visible are easier to identify as a reason to see a doctor. Swollen joints, fevers, significant changes in appetite, rashes, fainting, or any other symptom that would normally clue you in that something is not right that accompany your child's pain are signs it's time to make an appointment.
it may be a sign they have some underlying inflammation. Inflammation can be a sign of many different disorders. When our body perceives an injury, it sends oxygen and nutrient rich blood called inflammation to that area to try and heal the injury. It also sends antibodies and other immune cells to fight any infections that it may find there.
If your child has an injury or an autoimmune disorder that is lurking below the surface, you may not see swelling and inflammation to the naked eye. It may be deeper inside their bodies than you can see. When the barometric pressure drops before a storm blows through, the pressure of the air against your body tissues decreases. This means that the inflammation isn't squished out of your tissues back into circulation as easily. When the inflammation sits in your tissues it presses on the nerves which can make you feel achy and stiff.
Some children may also be temperature sensitive. If cold is painful, it can be a sign your nervous system is unhappy. Most adults with chronic pain tend to prefer heating pads over ice packs (although there are some, particularly those with visible swelling, that do prefer the cold). In older adults, we know that many retirees with aching arthritic joints frequently try to move towards warmer weather if they can afford it. While children can't move to another climate on their own, they may avoid certain activities. If your child doesn't want to play in the snow like other kids, or complains more about their pain in certain seasons of the year, these may be clues that something more is going on.
As a general rule, if your child has the same pain complaint, even intermittently for 3 months, it's time to see a doctor. While there are aches and pains in life that come and go, if your child consistently complains about their knees every other week for 3 months, it most likely isn't going to go away on its own. If you body is going to be able to heal an injury on it's own, it will usually do it within 3 months. Even when children break a bone, they usually wear a cast for 6-8 weeks. If you can honestly go to your child's doctor and say that the problem has been ongoing for 3 months, they should take you seriously.
Lastly, if your gut tells you something isn't right, trust it. You know your child best, and there is something to be said for a parent's instincts. (See, 3 Rules of Raising Kids with Chronic Pain) Even if you go to the doctor and they don't find anything, that is a better outcome than living with the regret of not having taken your child seriously if an issue is found later. Most people won't regret spending the money on a doctor's appointment in exchange for peace of mind. There are many parents who regret not trusting their instincts if their kids are later found to have had a legitimate medical issue.
For parents who have genetic health issues, seeing the signs of the same disorders in their children is easier. They recognize the symptom patterns from their own experiences. In these situations, some parents question when is the right time to get the issue formally diagnosed. (See: Is Getting Diagnosed Worth It?). It is worth acknowledging that the timing of getting a diagnosis for your child can impact how they view themselves. If you aren't sure about this, you can always send a message to your pediatrician to ask their opinion about how this impacts children.
The content written above is intended for educational purposes. These suggestions are intended to help validate parents concerns when they are legitimate reasons to seek medical attention for their children. The above reasons to seek care are not an all inclusive list. If you are unsure, we encourage you to consult your medical provider for individual advice for your specific situation. If you are interested in scheduling a physical therapy evaluation, click the book now button at the top of the page.