Hesperian Health Guides

How to know when a child is in pain

Every day 20,000 people visit the HealthWiki for lifesaving health information. A gift of just $5 helps make this possible!

Make a giftMake a gift to support this essential health information people depend on.


HealthWiki > Helping Children Live with HIV > Chapter 13: Helping children with pain > How to know when a child is in pain


Children show they are in pain in many ways. Some are easier to see and understand than others. But you know your child, and if you watch and listen closely and think of how your child usually behaves, you can often tell when something is wrong.

HIV Ch13 Page 250-1.png
HIV Ch13 Page 250-2.png
Some types of pain are sharp, sudden, and caused by something easy to see and understand Some pains are caused by things you cannot see, such as joint pain or headaches. These can be just as hard on a child as a bad cut, especially if they are long-lasting.

Common signs of pain in children

Because children are not always able to describe or tell us about pain, we have to watch for signs.

HIV Ch13 Page 250-3.png
  • Cries, groans, or moans when touched or moved, or without an obvious reason
  • Is upset or unable to rest
HIV Ch13 Page 250-4.png
  • Holds a painful part of the body
  • Does not move a part of his body
HIV Ch13 Page 250-5.png
  • Has fever or heavy sweating
  • Breathing and heartbeat are fast
HIV Ch13 Page 250-6.png
  • Keeps to himself, is sad, or is very quiet
  • Refuses to eat or play
HIV Ch13 Page 250-7.png
  • Holds hands over ears to keep out noise
HIV Ch13 Page 250-8.png
It hurts, mama!
  • Talks about what hurts
HIV Ch13 Page 251-1.png
A quivering chin, clenched jaw, or grimacing face can be a sign of pain.

Signs in babies

Look for crying and signs of distress on the baby’s face or in how he holds his body. He may tap his head if it hurts.

HIV Ch13 Page 251-2.png
HIV Ch13 Page 251-3.png
A child in extreme pain may hold her whole body very stiff and still, or strongly arch her back.

Pain may also cause a baby to tense her legs, either kicking them out or drawing them up towards her chest. Or if pain is very strong, it may make a baby move around a lot.

a woman thinking
He ate, he is dry, why won’t he stop crying? Maybe his arm hurts. He cries louder when I touch it.

If your baby is crying and you know he is not hungry, wet, or tired, think about whether he might be in pain. Crying that sounds different from usual may be a sign of pain.

a child talking to a doll.
Head hurt, baby?

Signs in young children

Children old enough to talk or play have more ways to show you they are in pain. Sometimes children show you by how they play.

A child in pain may pull away or cry out when you touch him. You may think he does not want you near, but he will usually stay near enough so he is not left alone.

Children can also have pain and show no signs, especially if they are very weak, or have had pain for some time and have grown used to it.

How to talk with young children about their pain

If your child is old enough to talk, you can ask her to tell you about her pain. Sit at the child’s level and be gentle and patient. A child in pain may need more time and help to answer questions.

It may help to ask about pain in different ways:

HIV Ch13 Page 252-1.png
Is it a little or a lot?
Is it sharp or more like squeezing?
HIV Ch13 Page 252-2.png
What makes it worse? What makes it better?
HIV Ch13 Page 252-3.png
Point on the doll to where it hurts on you.


Children older than age 5 may be able to use a simple pain scale. Say how much pain it means as you hold up different numbers of fingers. Then ask the child how many fingers best describes the pain he feels. But even adults have problems describing their pain, so do not rely on this alone — watch and talk with the child.

HIV Ch13 Page 252-4.png
No hurt
Hurts a little bit
Hurts a little more
Hurts even more
Hurts a whole lot
Hurts worst

Believe a child when she says she has pain. No one wants a child to hurt, so sometimes we want to believe a child is not really in pain. In fact, many children try to hide pain to stop you from worrying. Or they may want to avoid medicines or an injection. Also, if a child thinks pain is a punishment for doing something “bad,” she may try to hide it so you will not know she was “bad.”

an older child speaking to a younger one.
Does this hurt?
No
He is trying to be strong, but his face shows pain.


When talking to a young child, look for signs of pain and discomfort. Keep in mind that children in constant pain sometimes stop showing their pain much, and do not know how much they are hurting or how to describe their pain.

a woman speaking to a young girl.
Your mother tells me you take good care of Sam. What works best when he is in pain?


If you are a health worker, ask the child’s mother or other caregivers how the child has been acting, what he is like when he is not sick, and how they think he feels.


an older child speaking to a younger one.
Hello Ishmael. My name is Summayya.
Can you help me draw some pictures?


When you first meet a sick child, get to know him a bit before you ask about pain. See Chapter 4: Communicating with children.


It may help to watch your child for signs of pain when she is playing or talking with another person — she may show her pain differently



This page was updated:27 Nov 2019