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For many parents, helping their child deal with pain is among the more difficult tasks they face. Babies and toddlers can’t tell you what’s wrong because they lack language skills. Even older children can have a hard time articulating the cause of their pain, whether it’s a headache or muscle strain.

As a parent, you often have to guess the cause of the problem. Whether the pain is chronic or sudden, you want to figure out what’s wrong and help fix it. Here’s what you need to know about pain in children.

Chronic and Sudden Pain in Children

There’s no doubt that children of all ages feel pain. The causes of sudden, short-term (acute) pain range from swollen glands to sports injuries. For instance, sudden ear pain in a child can signal an ear infection.

But not all childhood pain is fleeting. According to the Society of Pediatric Psychology, 11% to 38% of children experience chronic pain (pain that lasts at least three months). Recurring pain in children can come from multiple causes, including a chronic disease (like rheumatoid arthritis) or an injury that isn’t healing.

Figuring out the source of pain can be a complicated task. Sometimes, there’s a combination of physical, psychological, and social factors at work. (For instance, when a child has chronic headaches but only on school days.)

Here are some signs of pain in children and how to cope with them.

Signs of Pain in Babies and Toddlers

Babies can’t talk, but they can give you signals that something is wrong. Though toddlers have more language skills than babies, they usually can’t tell you anything specific about their pain. When a baby or toddler is in pain, they may display the following behaviors:

• Arching the back and drawing up the legs.
• Becoming unusually withdrawn.
• A change in the tone of their crying.
• Changes in behavior (not eating normally, getting fussy or restless).
• Crying more than usual or not responding to things that usually comfort them.
• Disruptions in sleep patterns.
• Facial expressions of anger, a furrowed brow, or closed eyes.
• Flailing or thrashing arms and legs.
• Irritability.
• Pointing to the body part that hurts.
• Tugging on or rubbing an ear.

Causes of Pain in Babies and Toddlers

Common causes of pain in young children include:

• Bumps and falls.
• Colic.
• Constipation.
• Ear infections.
• Strep throat.
• Teething.
• Urinary tract infections.
• Vaccinations.

Signs of Pain in Older Children

Older children may tell you where the pain is and when it started. But it’s still not always easy to figure out what’s wrong. Pain management becomes more complex as children age.

Older children and teens may:

• Act irritable.
• Avoid going to school.
• Avoid sports or other physical activities they used to enjoy.
• Experience changes in their eating and sleeping habits.
• Regress to an earlier developmental stage (like wanting to sleep with a parent).

Causes of Pain in Older Children

Older children and teens may experience pain from:

• Allergies. Food allergies can cause cramps, bloating, and diarrhea.
• Emotional upset. Anxiety and depression can trigger headaches and stomach pain.
• Growing pains. Your child may wake up at night complaining of aches in their arms or legs. So-called “growing pains” such as sudden leg pain in a child can result from overstraining muscles during play or sports during the day.
• Menstrual cramps. Many teens have severe cramps near the beginning of their period.
• Migraines. Stress and hormone fluctuations can contribute to severe headaches.
• Sports injuries. Strained muscles, shin splints, and other problems can come from overdoing it.

Treating Your Child’s Pain

Acknowledging your child’s complaints about pain is crucial. You can treat your child’s mild illnesses and injuries at home. Try these tactics:

• Cuddle with your child. The simple comfort of having you close and getting one-on-one attention can help with pain.
• Distract your child with a book, toy, or favorite TV show.
• Encourage your child to have a bowel movement.
• Encourage your child to nap.
• Figure out the root of emotional stress. Something may be troubling them at school, or they may be responding to a family issue such as divorce or moving. Your pediatrician can refer you to a child therapist who can help them sort out their feelings.
• Give your child acetaminophen (Tylenol) or other pain medicine after checking with your pediatrician. Don’t use ibuprofen (Advil) for a baby under six months old. Never give aspirin to anyone under 18 because it can cause Reye’s syndrome, a serious illness.
• Let your child play in a warm bath to ease muscle aches.
• Massage your child if it seems to help. (But know that some children don’t enjoy any form of touch when they’re in pain.)
• Try a cold pack on a sore limb.
• Use a heating pad for menstrual cramps.

When You Should Call the Doctor

Aches and pains come and go throughout childhood, and most aren’t serious. However, you should call your pediatrician if your child has:

• Belly pain that comes and goes for more than a week.
• A burning sensation when they pee.
• Dark urine.
• A desire to sleep more than normal.
• Diarrhea for more than two days.
• A lump in a muscle that doesn’t go away.
• Fever over 100.4 degrees Fahrenheit.
• No appetite for more than two days.
• Stomach pain with fever but no diarrhea in a child.
• Swelling that doesn’t decrease after 24 hours, even with rest and ice.
• Unexplained weight loss.
• Vomiting for more than 12 hours.

You should call 911 or go to the nearest emergency room if your child:

• Develops a stiff neck. Sudden neck pain in a child with a fever over 100.4 Fahrenheit is a possible sign of meningitis.
• Has a hard, rigid belly.
• Had a recent injury to the belly.
• Had sudden, sharp belly pain.
• Has trouble breathing.
• Is limp and floppy, or hard to wake up.
• Is unable to pass stool and is also vomiting.
• Is vomiting blood or has blood in their stool.
• Is younger than 3 months and has diarrhea or vomiting.

For some children and adolescents with chronic pain, the patient’s treatment may involve multiple specialist visits and may not reveal any underlying cause of the pain. Chronic pain is itself a disorder and UPMC offers comprehensive multidisciplinary treatment teams to help your child to feel better and live their life as normally as possible.