Childhood is filled with scrapes, bruises, and falls. When a minor injury occurs, children usually shed a few tears, receive a hug and a bandage, and promptly move on. But for some children, pain is a way of life. When a child suffers from something more serious, like cancer, burns, or pediatric arthritis, the management of pain becomes a primary, ongoing concern for both the child and the adults in the child’s life.
The purpose of pain is to tell us that a part of the body is hurt, and that it needs attention and protection in order to heal. But pain is more than the biology of nerves sending messages to the brain. A child’s experience of pain can also depend on the child’s personality, culture, and earlier painful events. It can even depend on the child’s expectations of how someone should react when hurt, as parents know from watching a toddler who takes a tumble and then looks to them before deciding whether to cry.
Pain, therefore, has a very real psychological dimension. How a child understands pain, reacts emotionally, and behaves in response to it can heighten or reduce the pain sensation. Here we introduce two psychological interventions—imagery and deep breathing.
In age-appropriate terms, explain to your child that thinking about one thing leaves less space in your brain for thinking about other things, such as pain. You might provide some examples to make this idea more real, including times when your child was busy playing a game and didn’t hear you calling or didn’t feel hungry even though it was dinnertime.
Ask your child to imagine what it would be like to actually be inside of a relaxing picture. Explain that the more they can imagine themselves this way, the less they will be aware of any pain that might be bothering them. Ask them what some of their own relaxing or uplifting “pictures” are. You can help them come up with ideas by volunteering some of your own; explain how thinking about them helps you feel better. For example, you might say, “When I have a headache, it helps me forget about it when I think about the beach we visit every summer. I can imagine the rushing sound of the waves and the seagulls calling, and I can feel the cool sea breeze on my skin and the warm sand under my feet.” Help them find and experiment with images they personally find most comforting and empowering.
Focus on their images and encourage them to imagine the scene in detail using as many senses as possible. For example, what would a field of daisies look like and smell like? How would it feel to be curled up in a tiny flower, and what would they hear as the wind whispers through the petals? Use a gentle and reassuring voice as you discuss the images together.
On its own, deep breathing can help relax a child, which can help reduce pain. When combined with imagery, the pair can be even more effective than either technique by itself.
You don’t need to wait until your child is in pain to teach deep breathing skills. Explain that when people feel scared, upset, or even in pain, breathing deeply and slowly can help them calm down and feel better. You can also explain that it’s a good idea to learn this kind of breathing before it’s actually needed. That way, when your child does need it, it’s right there, ready for use.
When teaching this skill, start by asking your child to find a comfortable position. They can be sitting up or lying down. Then you might say, “First, blow all of the air out of your lungs…. Now, breathe in s-l-o-w-l-y until your tummy feels full of air…. Now breathe out slowly, until your tummy muscles have pushed all of the air out of your body.”
They might imagine their abdomen as a balloon that is first filled with air and then completely deflated. Breathing in and out in this way, using the abdomen rather than the chest, is most effective for relaxing the body. If possible, they should breathe in through the nose and slowly out through the mouth. Their breathing should follow a regular, relaxed rhythm. Breathe with your child to demonstrate the technique and set the right pace, and speak with a soft, gentle voice.
At first, they may need the room or space to be quiet as they try to relax through deep breathing, but with practice they will be able to use this relaxation tool more easily when and where it is needed.
Coping with Chronic or Recurrent Pain
It is important for children to feel they have some control over their pain. This is especially true when the pain is chronic (such as pain associated with pediatric arthritis, severe burns, or cancer) or recurrent (pain that comes and goes, like the severe pain crises of sickle cell disease). Total pain relief may not be possible in these instances, but children feel less anxious and fearful if they know there is something they can do themselves to lessen their discomfort.
Encourage your child to discuss the pain openly. Some children may hesitate, believing that you expect them to be “grown-up.” Boys may also be more reluctant than girls to admit that something is hurting. Explain to your child that being brave does not mean denying pain. Instead, it means talking about it and making plans together to feel better. Ask specific questions, such as, “When did the pain start?” “Where does it hurt?” and “What does it feel like?” For younger children, you may need to provide some options for describing the pain, such as “sharp like needles” or “hot and burning.”
Imagery and deep breathing can be helpful on their own in instances of mild pain or during procedures that entail brief and minimal discomfort. Chronic or recurrent pain requires more comprehensive pain management that can include medication, as well as psychological and physical techniques developed in consultation with a healthcare team. Although pain medications can be effective, imagery, deep breathing, and other strategies that give your child some control are important tools.
Coping with Medical Procedures
Fear makes pain worse. In cases of pain related to medical procedures, such as injections and biopsies, a child who has learned what to expect may be especially anxious and in need of pain management strategies. Avoid making promises that a medical procedure won’t hurt when in truth it will. False messages can confuse children and, in the long run, increase their fear and anxiety as well as their pain.
Try relating the discomfort of an upcoming medical experience to something familiar or imagined. For example, telling children they may feel tingling for a specific procedure, like the pins and needles they feel in their toes on a cold winter day, may reduce some worry.
Practice imagination and breathing techniques together with your child before a procedure. You may need to work closely with healthcare professionals, such as psychologists, to come up with strategies for relaxation and imagination during complex, painful procedures such as lumbar punctures.
Practicing the Skills
Children should be taught that they can use their imagination and deep breathing techniques anywhere and anytime, even without you. Help your child perform these techniques when they are not in pain. Practice will help your child use these techniques independently and spontaneously for comfort and relief.