Pain in Children: Pediatric Pain Facts, Signs and Care

Author: Ian C. Langtree - View Credentials
Published: 10 Sep 2015 - Updated: 13 Oct 2026
Publication Type: Informative

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This information explains how pain in children is defined, how often it occurs and why it is still under-recognized and under-treated, drawing on the revised 2020 International Association for the Study of Pain definition, a 2024 global meta-analysis published in Pain and clinical reports from the American Academy of Pediatrics. Roughly one in five children and teens lives with chronic pain, with headache and musculoskeletal pain the most common types and girls affected more often than boys for most pain types. It is useful for parents, caregivers, teachers and health professionals, and especially for families of babies and children with disabilities, because it stresses that a child who cannot describe pain in words may still be hurting and lists the behavioral signs to watch for, along with an outline of current treatment approaches.

At a Glance

• 1 - Nociceptive pathways are working by about 25 weeks of gestation, so even very premature babies feel pain.
• 2 - About 220,000 U.S. children and teens under 18 have arthritis, roughly 305 for every 100,000 young people.
• 3 - A large French study found pain relief was given specifically before only 21 percent of newborn procedures.
• 4 - In children with significant brain or nervous system impairment, recurring pain often comes from reflux, spasticity and hip subluxation.

Topic Definition

Pediatric Pain

Pediatric pain is pain experienced by infants, children and adolescents, described by the International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. It can be acute, such as pain from an injury, surgery or medical procedure, or chronic, meaning persistent or recurring pain or pain lasting longer than three months. Because a child's ability to understand and report pain depends on age, development and communication skills, pediatric pain is assessed using both self-report and observation of behavior, and it is managed with a combination of physical, psychological and medication-based approaches suited to the child.

Overview

What Pain Is and How It Is Defined

Pain is a signal processed by the nervous system and the brain, and it can be sharp or dull, constant or on and off. The International Association for the Study of Pain (IASP) revised its definition in 2020 and now describes pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage [Raja et al., 2020]. The IASP also notes that verbal description is only one of several ways people express pain, and that an inability to communicate does not mean a person is not in pain [International Association for the Study of Pain, n.d.]. That point matters a great deal for babies, young children and children with communication disabilities.

Acute pain is a warning sign. It helps diagnose a problem and usually fades once the cause is treated. Chronic pain is defined as persistent or recurring pain, or pain lasting longer than three months [Chambers et al., 2024]. It may come from an ongoing condition such as arthritis, or continue after the original injury has healed, and it affects a child's nervous system differently and needs a different treatment approach.

How Common Is Pain in Children?

Every child experiences pain at some point, from everyday bumps and bruises to headaches, stomach aches and long-term health conditions. A 2024 systematic review and meta-analysis of 119 studies, covering more than one million children and teens in 70 countries, found that 20.8 percent of children and adolescents live with chronic pain. Headache and musculoskeletal pain were the most common types, each at 25.7 percent [Chambers et al., 2024]. Girls had higher rates than boys for most types of pain, although the review found no significant difference for back pain or musculoskeletal pain.

Arthritis is one cause that is often overlooked in young people. Using national survey data from 2017 to 2021, the Centers for Disease Control and Prevention estimated that about 220,000 U.S. children and adolescents under 18 have diagnosed arthritis, or 305 per 100,000 [Lites et al., 2023]. Arthritis was more common among children who also had depression, anxiety or a heart condition.

Why Pediatric Pain Is Often Under-Treated

Pain remains one of the most under-recognized and under-treated health issues in children. Assessing pain is harder in children than in adults because how a child understands and reports pain depends on their stage of development, and children of the same age vary widely in how they perceive and tolerate it. Common reasons pediatric pain is missed or under-treated include:

• Children and adults react to and describe pain differently
• Clinicians may focus on finding the cause and overlook relieving the symptom
• Some health professionals have limited training in pediatric pain management
• Concern about medication side effects can lead to too little treatment

Hospital standards have changed. The Joint Commission, the U.S. accrediting body formerly known as JCAHO, revised its pain assessment and management standards for hospitals, effective January 1, 2018. Hospitals must screen patients for pain during emergency department visits and at admission, and must set criteria to screen, assess and reassess pain that fit each patient's age, condition and ability to understand [The Joint Commission, 2017].

Pain in Newborns and Infants

Babies were once thought to feel little pain, but that view has been overturned. According to the American Academy of Pediatrics, the pathways that carry pain signals are working by about 25 weeks of gestation. Because the spinal and descending circuits that dampen pain are still immature, newborns can have exaggerated responses to painful stimuli and become more sensitive to later ones [American Academy of Pediatrics Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine, 2016]. The most premature infants also tend to undergo the most painful procedures. A large French study cited in the same report found that pain relief was given specifically before only 21 percent of procedures.

Simple, low-risk measures can help. The AAP report notes that breastfeeding during a heel stick or blood draw reduces pain responses in full-term newborns about as well as oral sucrose or glucose, and that skin-to-skin contact may ease some measures of pain. Sucrose is commonly used for minor procedures, but the AAP recommends prescribing and tracking it like a medication because its long-term safety with frequent use is still unclear.

Pain in Children With Disabilities

Children with significant impairment of the central nervous system, such as severe cerebral palsy or intellectual disability, experience pain often, and those with the greatest impairment have the most frequent and severe pain. An American Academy of Pediatrics clinical report found that these children remain at risk of having their pain under-recognized and under-treated [Hauer and Houtrow, 2017]. Recurring pain in this group often comes from gastroesophageal reflux, spasticity and hip subluxation, while some pain comes from the nervous system itself and cannot be confirmed with diagnostic tests. The report reviews behavioral pain-assessment tools designed for children who cannot describe their pain in words.

Signs of Pain in Children

Certain behaviors can alert a parent or caregiver that a child is in pain, even when the child cannot say so. Watch for:

• Decreased physical activity
• Avoiding contact with other children
• Changes in sleep pattern or appetite
• Favoring one leg or arm over the other
• Irritability, crankiness or unusual behavior
• Facial expressions of pain such as wincing, gasping or frowning
• Physical cues such as flushed skin, dull eyes, sweating or rapid breathing

It helps to go over words that describe pain so children can choose the ones that fit what they feel, such as itchy, sore, aching or burning. Do not rely on words alone. Ask the child to point to where it hurts and show how the pain moves. Clinicians use self-report scales with children old enough to rate their pain and behavioral observation tools with younger or nonverbal children. Parents and caregivers, who know a child's usual behavior best, are an important part of that assessment.

How Unrelieved Pain Affects Children and Families

Pain protects us from harm, but pain that goes unrelieved can do harm of its own, both physically and psychologically. Untreated pain raises fear and anxiety, which in turn can heighten the perception of pain. If it is not addressed early, pain can affect a child's quality of life by interfering with:

• Sleep
• Mood
• Appetite
• School attendance
• Academic performance
• Sports and other extracurricular activities

Early experiences of pain may also have lasting effects. In newborns, early repeated pain is associated with altered brain development and changes in the systems that handle stress and sensation, which may persist into childhood [American Academy of Pediatrics Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine, 2016]. Pediatric pain also affects whole families. Parents may face healthcare costs and missed work while caring for a child in pain.

Current Approaches to Managing Pain in Children

The goal of treatment is to reduce pain and help the child return to normal daily life. In 2020 the World Health Organization published its first guidelines on managing chronic pain in children and adolescents aged 0 to 19 [World Health Organization, 2020]. The guidelines cover physical, psychological and medication-based approaches, and they seek to balance access to pain relief against the risks of medication misuse and side effects. Many children do best with a combination of these approaches, coordinated by their healthcare team. Parents and caregivers who are concerned about a child's pain should speak with a pediatrician or other qualified health professional about an assessment and a plan suited to the child's age, condition and abilities.

Frequently Asked Questions

When should a parent take a child's pain to a doctor?

Seek medical advice if pain is severe, keeps coming back, lasts more than a few days, wakes the child at night, or comes with fever, swelling, limping, vomiting or weight loss. Any pain that stops a child from attending school or playing normally should also be checked by a pediatrician.

Is it safe to give children aspirin for pain?

Aspirin is generally not recommended for children and teenagers unless a doctor advises it, because it has been linked to Reye syndrome, a rare but serious illness affecting the liver and brain. Ask a pharmacist or pediatrician which pain reliever and dose are right for the child's age and weight.

What is a pediatric pain clinic?

A pediatric pain clinic is a specialty service where a team that may include doctors, nurses, psychologists and physical therapists works with children who have chronic or complex pain. The focus is usually on reducing pain and helping the child return to school, sports and normal routines.

Should a child with chronic pain stay physically active?

For many types of chronic pain, gentle and gradually increasing activity helps rather than harms, because long periods of rest can lead to stiffness, weakness and more pain. A doctor or physical therapist can advise on safe activity levels for the child's specific condition.

How can parents reduce pain during vaccines and needle procedures?

Holding the child, breastfeeding or offering a bottle for infants, and using distraction such as toys, videos, bubbles or slow breathing can all help. Numbing creams may be an option for some procedures, so ask the clinic in advance what is available.

How can schools support a student with chronic pain?

Schools can offer accommodations such as rest breaks, flexible attendance, extra time for assignments, elevator access or modified physical education. In the United States, a Section 504 plan or an individualized education program can formally set out these supports.

Can psychological therapy help with physical pain in children?

Yes. Approaches such as cognitive behavioral therapy and relaxation training do not mean the pain is imaginary - they teach children skills to cope with pain, reduce stress and get back to daily activities, and they are often used alongside physical and medical treatment.

Are growing pains a real condition?

Growing pains are a common cause of aching in the legs of young children, usually felt in the evening or at night and gone by morning. They are generally harmless, but pain that is in a joint, occurs during the day, causes limping or comes with swelling or fever should be checked by a doctor.

References:

• American Academy of Pediatrics Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine. (2016). Prevention and management of procedural pain in the neonate: An update. Pediatrics, 137(2), e20154271.
• Chambers, C. T., Dol, J., Tutelman, P. R., Langley, C. L., Parker, J. A., Cormier, B. T., Macfarlane, G. J., Jones, G. T., Chapman, D., Proudfoot, N., Grant, A., and Marianayagam, J. (2024). The prevalence of chronic pain in children and adolescents: A systematic review update and meta-analysis. Pain, 165(10), 2215 - 2234.
• Hauer, J., and Houtrow, A. J. (2017). Pain assessment and treatment in children with significant impairment of the central nervous system. Pediatrics, 139(6), e20171002.
• International Association for the Study of Pain. (n.d.). IASP terminology.
• Lites, T. D., Foster, A. L., Boring, M. A., Fallon, E. A., Odom, E. L., and Seth, P. (2023). Arthritis among children and adolescents aged less than 18 years - United States, 2017 - 2021. Morbidity and Mortality Weekly Report, 72(29), 788 - 792.
• Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X.-J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., and Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain, 161(9), 1976 - 1982.
• The Joint Commission. (2017). R3 report issue 11: Pain assessment and management standards for hospitals.
• World Health Organization. (2020). Guidelines on the management of chronic pain in children.

Insights, Analysis, and Developments

Editorial Note: Pediatric pain is easy to miss because children rarely describe it the way adults do - a toddler may simply stop playing, a teenager may start missing school, and a nonverbal child may show pain only through changes in sleep, appetite or muscle tone. Hospital standards now require pain screening that fits a patient's age and ability to understand, and the World Health Organization's first guidelines on chronic pain in children support combining physical, psychological and medication-based care. Pain that goes unrelieved can feed fear and anxiety, disrupt learning and friendships, and place real financial and emotional strain on families, so the people who know a child best - parents, caregivers and teachers - play a central role in noticing changes early and pushing for a proper assessment.

Author Credentials: Ian C. Langtree is a writer, editor, and the founder and Editor-in-Chief of Disabled World, which he established in 2004 as one of the longest-running independent resources for disability news and information. Over more than two decades, he has written and edited thousands of articles on disability rights, health, accessibility, and assistive technology. Drawing on a global perspective shaped by extensive travel and lived experience, Ian is a committed advocate of the Social Model of Disability, the framework developed by disabled activists in the 1970s that focuses on removing societal barriers rather than on individual impairments. His writing is grounded in that framework and in a lasting commitment to disability rights, accessibility, and social inclusion. To learn more about Ian's background, expertise, and accomplishments, visit his full biography.