2012年3月2日 星期五

Teaching Kids to Deal with Pain

Thirty years ago on a little league field in New York State a youngster injured his thumb when he was hit with the ball. The coach, who was also his father, looked at the digit, declared it couldn't be too bad, so "be tough," and sent the kid back into the game. Moments later, with his thumb turning a rainbow of shades and expanding to three times its usual size, the child's mother yanked him off the field, and over the protests of his father, drove him to the emergency room. The doctor pronounced the thumb to be broken. At home that evening, after being told that his son's thumb was broken, the father said he felt bad about his hasty judgement.

Though this scene took place two decades ago, it repeats itself (maybe under some variation) every year. Parents oftentimes brush off their children's pain in an effort to dam the tears and curb the wailing. We are not intentionally trying to be mean. Let's face facts, our child's crying, when it is caused by injury, pains us. We do not want our children to be hurt or to feel pain. We may go as far as thinking, if only I could take this pain from her or him.

A child who is seriously ill or injured evokes sad emotions and causes us to think that life is unfair. The image of that ill child is out of our comfort range. Our mental images of children revolve around rosy faced, boys and girls with wind-blown hair, playing and laughing, enjoying life and sunshine.

But in reality, children do get hurt, sometimes seriously, and it may take more than a Band-Aid to make the boo-boo go away. When our children take a tumble as they learn to walk, take a spill from their bikes, or fall from a tree they have proudly climbed, we need to know how to handle the situation. Our mental attitudes, words and physical actions influence the amount of pain children feel, the level of hysteria they will reach and their mental associations about pain and life.

But in order to adequately help our children during times of crisis and both physical and emotional pain, we need to examine what pain is, its causes and types and its "cures". Parents are a child's first teachers in life. We are also our child's first teachers about pain.

What is pain?

Pain is a subjective sensation. What may be painful to one person or child may not be as painful to another. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage." Pain is the body's signal that it has been injured or that something is wrong. So, in essence, pain can be good, but it can also interfere with our lives and our bodies' functioning.

Sometimes diagnosing a child's pain can be difficult, especially in infants and younger children. The only authority on a child's pain is the injured child; just as the only authority on an adult's pain is the injured adult. We cannot feel another's pain; we can only read his verbal and nonverbal cues to understand the intensity he is feeling. We need to keep this in mind when we are treating our child's injury.

Scientists and psychologists have studied pain for years. Back in the seventeenth century the philosopher Rene Descartes believed that the mind and body were separate entities, therefore creating misconceptions about pain, saying that our thoughts and feelings had no influence on our pain. Even in more recent years, researchers and doctors did not believe infants and children could feel intense pain because they were neurologically immature, and that their cries and screams were caused by fear. In the 1930s the prevalent mindset was that if a doctor gave an infant a sugar sucker, no anesthesia was needed during surgery, whether that surgery was a circumcision or for something more life-threatening. We, as a society and as researchers, have come a long way since then, but only recently. In 1985 in Washington D.C., baby Jeffrey Lawson was born prematurely and needed heart surgery. Doctors gave the baby the proper anaesthetic analgesia, but he received no post-operation pain medications. Baby Jeffrey died shortly after surgery, and during this landmark case, it was proved he died from the intensity of the pain.

This case caused the International Association for the Study of Pain to form the Special Interest Group on Pain in Childhood in 1986. Because of their work, and the research of other similar groups, we now know that children of all ages do indeed feel pain and this pain is often more intense and frightening than the pain that adults experience. We also have now realized that the child is the ultimate authority on the pain he or she is feeling.

In July of this year, a research team at John Hopkins University and the National Institute on Drug Abuse (NIDA) reported, in the Proceedings of the National Academy of Sciences, that they had found a single gene that could explain why injuries that spell mere discomfort for one person could be mean agony for another. This gene, which controls the mu opiate receptor (a molecule that helps the body's natural opiates enter cells), also provides clues as to why some people get more relief than other from opium-based painkillers.

Dr. George Uhl, of NIDA, said, "People have long been skeptical that pain has a genetic basis. Many assume the way people respond is voluntary. 'Just put up with it' has been a common recommendation for years. But now people can think of pain as a genetically regulated problem."

Causes of Pain

Genes are not the only causes of how intense pains could be. Many factors influence the way we feel pain. Child psychologist Leona Kuttner, Ph.D., in her book A Child in Pain: How to Help, What to Do (Hartley and Marks), includes these factors:

· sex

· temperament

· cultural norms

· parent's anxiety level

· child's anxiety level and perceptions

· extent of physical injury

· amount of stress

· type of analgesia (pain reliever) used

· developmental level

· previous painful experiences

These factors combine to determine how painful the situation is and how the child will respond. If a parent gets hysterical or faints upon seeing an injury, the child is apt to think her injury is very serious, and possibly even life threatening.

Likewise, if injury is seen as a positive occurrence, then the pain will be less severe. Boston surgeon H. Beecher studied this phenomenon during World War II. Soldiers, who were injured in battle with injuries similar to their civilian counterparts, required less pain medication. To the soldiers, a wound meant a ticket home, so the pain they were feelings was positive.

In other examples of how cultural norms affect intensity of pain, if a boy has been taught by society that crying is bad and that "boys don't cry and only sissies get hurt," he is apt to "tough it out" and say that nothing is wrong, even if he has a serious injury. With this attitude, he may end up doing further damage to the injured body part, just like the boy in the example at the beginning of this article.

In addition to these external factors, the intensity of our pain is also based on internal factors. Kuttner writes, "When the body experiences an injury, nerve impulses at the site of the injury send a message to the brain. The nerve impulses alone are not the pain; only when they reach the brain are they defined, felt and experienced as 'pain'."

Your child, based on a past negative experience with a needle, may interpret the shot about to be administered not only as a physical discomfort but also as a huge threat. Because of these feelings, she may feel more pain from that needle pierce than her friends would.

Recently, researchers in England suggested that newborns may have more of the chemicals in their spinal cords that cause the experience of pain than adults do. But, infants have no way to articulate what they are feeling (other than by crying) and do not know mechanisms--internally and externally--to shut down the pain as older children and adults do. So it is important for us, as parents, to watch our children closely to pick up the nonverbal clues on how they feel.

Classifications of Pain

Three main types of pain exist for people of all ages: acute pain, chronic pain and recurrent pain. These pain types vary in cause, longevity and intensity.

Acute pain is usually immediate and lasts for a short duration of time, usually less than two weeks. This type of pain is often caused by an injury, a short-term illness or a surgical or medical procedure. Acute pain can be treated with analgesics, including over the counter and prescription medications. It can also be eased with nonpharmacologic means such as hypnosis and acupuncture or acupressure. If acute pain is untreated, it can cause significant emotional and physical distress.

Chronic pain persists for a time period beyond three months and includes both constant pain, such as that caused by a terminal illness, and intermittent pain, such as that caused by an intestinal or stomach disorder. Chronic pain may represent an illness, but oftentimes the cause of the pain remains undiagnosed. This type of pain frequently wears the sufferer down into thinking it is normal or "just a part of life." Chronic pain should not be a part of life.

According to Kuttner, recurrent pain is "pain that alternates with pain-free periods." Recurrent pain includes migraines and tension headaches, back pain and many other common problems. In children, recurrent pains may include for a period of time what we label as "growing pains." Five to ten percent of all school-aged children suffer from recurrent pains.

One pain these children occasionally complain about is headaches. The National Headache Foundation classifies this recurrent child's pain into five categories: tension-type, vasodilation or vascular, internal traction, inflammation and neurogenic or epileptic.

Your child's tension-type headache, according to the Foundation, is "probably caused by poor posture, worry, anxiety or depression." It is characterized by a tightening in the muscles, particularly those around the neck.

Vasodilation or vascular headaches are caused by the dilation and/or expansion of the blood vessels and arteries in and around the skull. This swelling forms a pressure across the forehead, oftentimes creating what we know as a migraine.

Internal traction, most often associated with organic (meaning coming from within, not from external forces such as a strong odor or stress) headaches, indicates the presence of a tumor, abscess, infection, swelling or hematoma. This type of headache is very serious.

Inflammation headaches also require immediate medical care, as they accompany another problem, usually a disease of the eyes, ears, nose, teeth or sinuses, or a neck or jaw disorder. This type of headache occurs when your child's tissues are injured or irritated and become inflamed.

Lastly, "some children's headaches are accompanied by seizure-like behavior, similar to children who have epilepsy." Tests on a neurogenic or epileptic headache will not usually reveal a clinical cause, but "a passing neurological disorder that can be managed with medication and might eventually disappear on its own," according to the National Headache Foundation.

Easing the Pain

Your six-year-old has been whiny lately, complaining of a headache. What should you do? According to Kuttner, we first need to respond to the pain in a caring practical manner. Ask on a scale of one to ten how bad it hurts.

Inform the child about what is happening in his body. Six-year-olds are in the exploratory age where they love to discover how things work, including the human body. Get out the encyclopedia if you have to and read it together. Not only will this create a bond if you "problem-solve" the headache together, but snuggle or hold the child while you research.

Acknowledge your child's pain without minimizing or denying it. Refrain from phrases such as "It can't be that bad." Ask exactly where it hurts so you can get an idea what type of headache the pain could be.

Discuss options with your child on what to do--a children's painkiller, a cool washcloth on the forehead, relaxing with eyes closed, thinking about happy things such as playing on the beach, etc.

Stay with your child through this experience, providing him with hope. Tell him it will go away soon.

Most of all, in any experience that is painful for your child, keep your own anxiety in check. If a child senses you are scared, he or she may become unreasonably scared, causing the hurt to be more painful than it is. Because, as Kuttner writes, "In every pain experience the brain integrates sensory and emotional information as well as thought processes."

But say your child has an injury more serious than a tension headache. What can you do to help her control the pain? According to Dr. Ronald Melzack in his book The Puzzle of Pain, you can teach your child to "gate the pain." "The pain impulse could be blocked, weakened or interrupted along the pathways to the brain." This is done by rubbing the limb, finger, etc., which activates a gating mechanism and inhibits the spinal cord's cells that transmit the pain message to the brain.

Another option for controlling pain is by using endogenons opioids, including the body's own endorphins. The brain, stomach and other organs have opioid receptors that naturally work to reduce pain. The immune system immobilizes cells that travel to the injury and release the endorphins. To release more opioids, medications such as morphine can be used.

Less potent medications, such as acetaminophen, ibuprofen and corticosteriods (such as hydrocortozone ointments) can also be used for some pain and injuries.

If you opt not to use medication, hypnosis can lessen pain by changing the experience of pain by focused concentration to alter consciousness. Stanford University psychologist Dr. Ernest Hilgard did a study by hypnotizing people and then asking them whether a normally painful sensation to the arm was painful. The patients wrote that severe pain was experienced in the brain's subconscious, but "because of the hypnotic trance it was not deemed 'pain' or perceived as 'painful'."

To hypnotize your child, you do not need the watch on a chain or the therapist's license. Just get him to strongly focus both mentally and physically on something other than the pain. You may even use a Where's Waldo book or one of those three dimension pictures with the hidden focal points that you can only see if you concentrate on the center of the print until your eyes go out of focus.

Most importantly, if your child is injured and in pain, don't panic. The child will not believe things will get better if you are not acting like they will. Give your child control over the pain control mechanisms that s/he will use, whether it be deep breathing, concentrating on something else, rubbing the injury, etc. Use language and ideas that invite hope. And pay close attention to the nonverbal indicators that reveal how the child is feeling. A child who has been in pain for a prolonged period of time may say anything to join his friends and appear "normal" again.

Children will get hurt and be in pain. This is part of their growing and learning experiences, just as it is a part of our learning experiences as parents to grow through our children's pain. Keep a positive outlook. And the next time David bumps his leg on the fireplace bricks after being told not to run in the house, do not say "That's what you get for not listening to me," but get out the ice pack and sit with him on the couch and explain what happened to his body. Pain should not be seen as a punishment but as a message to heed. And pain from bumping into the fireplace bricks may actually teach David that running in the house is not a good idea faster than any words or lectures you could say.

Jill L. Ferguson is an author, editor, public speaker and professor. She has written over 700 published articles and contributed to three nonfiction books. Her first novel, Sometimes Art Can't Save You, was published in late 2005 by In Your Face Ink.

This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.