Cuts, scrapes, and bruises are part of childhood. That curiosity and “f*ck around and find out” mentality helps build resilience long-term. While it’s expected for kids to whimper when they get a booboo at two, it’s a quandary when they continue to do it at eight. After one too many “Toughen up, Buttercups”, we started to wonder about pain tolerance in children. If they can’t handle a minor bug bite or dodgeball hit, then how do we expect them to handle a dun-dun-dun… flu shot?

But the truth is that pain is a highly complex and individualized experience, influenced by a multitude of factors. For today’s post, we’re deep diving into the concept of pain and how to better help our kids manage it. 

Pain Signals

We know that pain is an unpleasant sensory and emotional experience. However, it is a necessary biological response to uncomfortable sensory input from the environment or elsewhere. Pain functions as an alert mechanism when the body encounters potentially harmful stimuli, such as extreme heat, pressure, or cuts, prompting a reflexive response to prevent further damage. It also promotes healing by ensuring that the body remains aware of the injury, encouraging rest and limited activity.

Pain is unique because each person has a different pain tolerance and threshold. Although these two terms are often used interchangeably, they have distinct meanings.

Pain threshold refers to the point at which a stimulus triggers a pain response. Pain tolerance, on the other hand, is the maximum level of pain a person can endure before it becomes unbearable.

A good analogy of this difference is with temperature. The degree at which heat or cold becomes painful would be the pain threshold, while the maximum temperature you could withstand would be the pain tolerance.

Threshold and tolerance are subjective, influenced by several factors that include:

• Age. Children typically have a much lower pain tolerance than adults.
• Gender. Males generally have higher pain thresholds than females, possibly due to testosterone and societal expectations of stoicism.
• Mood. Stress raises cortisol and adrenaline, increasing pain sensitivity through inflammation and nervous system disruption. Anxiety heightens awareness of bodily sensations, amplifying pain. Sadness and depression lower the pain threshold, making chronic pain more likely.
• Expectation. Expecting higher pain can intensify the actual pain. Past painful experiences can make future pain feel worse due to anticipation.
• Neurodivergence. People with ADHD usually have higher pain tolerance; however, children with ADHD may be more pain sensitive. Children with autism often have higher pain thresholds but experience pain more intensely.
• Sensory processing. Children with sensory sensitivities often exhibit a lower pain threshold and tolerance, whereas those who are underresponsive to sensory input tend to have a higher pain threshold and tolerance.
• Other factors. This includes genes, cultural and societal norms, medications, and lifestyle.

Hurt Feelings

While the detection of pain is mostly reflexive (there’s no time to think when your life is in immediate danger), the pain signals eventually reach the brain to undergo complex processing to shape our pain perception. The brain interprets the data via:

• The thalamus: The thalamus relays pain signals to different brain regions and modulates the intensity of pain based on the situation. This is why some athletes often don’t feel their injuries until after the adrenaline wears off following a game.
• The somatosensory cortex: This area interprets the origin and intensity of body pain, mapping sensations to differentiate types (sharp vs. dull, localized vs. generalized).
• The limbic system: The region involves the emotional aspects of pain, influencing how it’s experienced and remembered. This explains why two people can endure the same injuries but have two different pain levels.
• The prefrontal cortex: This area is involved in the cognitive evaluation of pain. It integrates sensory and emotional inputs to form the overall experience and response to pain.

So why does any of this matter? Because when it comes to our kids and pain, their limbic system is in the driver’s seat. As per usual, their prefrontal cortex is not fully mature to independently figure out this sensation, why it hurts, and what to do. That means they are relying on:

• Observation. I fell. Mom, is it bad? Her face looks concerned. Should I be concerned?
• Exploration. Hmm, my elbow is red and hot to touch. Is this somewhere else on me?
• Previous experience. The last time I fell, it hurt so much and I was bleeding. OMG, that means I’m hurting so much and I’m bleeding right now! (starts crying).

When kids get hurt, it’s an emotional shock as much as it is physical. The crying is the emotional behavior to the incident because they can’t rationally wrap their head around the sensation. This means that parents must again become their prefrontal cortex to help them understand what they’re feeling and how to cope appropriately to ensure that the experience is not a traumatic one.

Pain Relief

Here are some things to keep in mind to help your child handle pain:

Be the Calm. Panic can create a powerful feedback loop as kids intuitively pick up on how adults around them respond to a situation. For instance, your child might not think much about getting a shot…until you show apprehension towards the needle which makes them second guess if they need to freak out (I speak from experience). But if you’re calm, your child will pick up on those tranquil vibes and try to remain calm themselves. Keeping your kids calm will help lessen their anxiety, which can then help lessen their perception of pain.

The True Meaning of Pain. Rethink the notion that pain is always “bad” or directly linked to injury. Instead, reframe pain as a sensation that’s there to protect us from physical harm in that situation. For example, getting pricked by a thorn in a rose bush. While no blood may have been drawn, that acute pain is a signal that the thorns are sharp and to be more mindful when handling them.

Acknowledge the Pain. When children cry over a minor injury, it can be tempting to dismiss their feelings with phrases like “Suck it up,” or “You’re fine.” However, this approach does not help them process the pain and associated emotions. Instead, it teaches them to suppress these feelings, which may result in stronger emotional reactions in similar situations later. Recognizing their pain can help it subside more quickly. Additionally, they can identify and understand other related emotions, such as fear and helplessness. Over time, they may cry only until the pain diminishes.

Remember, you are trying to help them process their mental and emotional reaction; you are not trying to normalize pain.

Let the Healing Begin. Let your kid know that their body is good at healing itself. If there’s a cut or scrape, platelets come and patch up the area. If there’s swelling, it’s to ensure the injured area doesn’t move too much to promote recovery. Let them know how they can help their body take care of itself by washing the area and putting a band-aid on it, icing a welt to reduce inflammation, or resting.

Get Back Out There. If your child gets hurt, encourage them to try again once they are physically and emotionally ready. Building resilience involves continuing activities after facing setbacks.

While it may be annoying to deal with every minor injury our kids face, we are creating safe environments during times of distress. As each painful experience becomes coded as a positive one, their ability to tolerate and manage discomfort will increase, allowing them to handle whatever life throws at them.

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Sources:
Teaching kids to deal with pain – Medical Republic
How Pain Works: The Nervous System’s Response Explained
Wallwork, S. B., Noel, M., & Moseley, G. L. (2022). Communicating with children about “everyday” pain and injury: A Delphi study. European Journal of Pain, 26(9). https://doi.org/10.1002/ejp.2008