My daughter twisted her foot last night and it has been bothering her since. I do not think she did any damage but she was still complaining about it this morning and I thought maybe I would share how I talk to her about it. Now, I am not a pediatric therapist and I am certainly not a child psychologist so this is just my experience based off of what I have learned from studying pain science and from how I educate adults about pain. The last thing we all need is another article telling us how to parent our kids - that is not my intent. My goal is just to get us all thinking about pain a little differently so that when it happens we have some tools to manage it.
First a little background about pain and pain science. Pain is an output from the nervous system, basically it's from the brain. That does not mean it is in your head - all pain is real. It is just that our nervous system generates the pain in an attempt to warn us of potential danger or to encourage us to move or change something. Pain does not originate from the injured area and it is not always an indicator of tissue damage. We can have pain with nothing broken or torn and we can have tissue injuries without pain. They are not one in the same and that is a very important fact to know. Our culture emphasizes pain as an indicator of damage that should be avoided at all costs and this may backfire and make pain much worse. This fear of pain may cause us to avoid movements that actually make us feel better because of the fear of making things worse. This is what we call fear avoidance and it is so prevalent with injuries.
My favorite example is neck pain. Most of us have had the experience of waking up in the morning and our neck is a little stiff. This can be for so many reasons, many of which have nothing to do with the neck itself. Our nervous system takes everything thing that is happening in our lives into account when determining whether or not to send pain, making it very complex and difficult to pinpoint an exact cause. We may have slept too long in an awkward position and our nervous system wants us to move and therefor sends a pain signal to alert us to change positions. We may not have slept well for other reasons, maybe we are more stressed than usual, or maybe we just spent too much time at the computer the day before and our neck muscles are just tired. Most times it's a combination of several factors. Some people just accept the pain, go about their day moving the head as normal and the pain resolves on its own. Others, thinking they are protecting the neck, will avoid painful movement at all costs. This reinforces to the nervous system that there is a need to protect the neck and the nervous system will continue to send pain. These patients will further limit motion and the cycle continues. These are often the patients that make it to physical therapy for that stiff neck weeks later. Once these patients are educated that it is safe to move the neck, the fear subsides and they move the neck and manage pain independently after just a few visits. It is really just the knowledge of what is happening that allows them to manage the pain.
Now with a little understanding of what pain actually is, lets get back to the kids. Parents, intuitively, already know a little bit about pain science. Most of us have said to ourselves "do not react." If you don't make a big deal when a toddler falls, they will bounce up and move on. If we react, they cry. This doesn't mean they are faking it or looking for attention. It goes back to the nervous system, they didn't damage anything when they fell, the brain didn't feel like it needed to protect something so they didn't feel pain. When they hear someone react, they become aware that something has happened and may actually feel pain. It is real.
So your child falls down, they bump their knee, it hurts. This is normal. It is scary. Its ok to show compassion.
A little hug is fine. Understanding pain does not mean we need to ignore it at all costs. That safe feeling from mom and dad may calm the nervous system and pain may ease. Sometimes that's all they need. But if the pain persists some, that is when I start educating. Of course there are times we need to see a doctor and rule out a significant injury. But, if there is no obvious swelling or injury, you can try a little pain science first.
So first I explain to my girls that their brain is doing a great job! It let them know that something happened so they could change it. It is protecting us. I like to explain touching a hot stove, pain lets you know to move the hand away and although it doesn't feel good, we need that pain to protect us. We then thank our brains. Sometimes I make up characters for the feelings like Painful Paul and Calming Carl. It helps them visualize it better and calms the fear.
The next part is harder, it might take time. I explain how when we move, even though it hurts a little, we are teaching our brain that it's safe now and that will help the brain to know to stop sending the pain. The dynamic between siblings can be a great analogy that kids can get. So this morning, I explained that her foot might just be a little cranky. It's a little mad that it got twisted and its just not quite ready to let go yet. Just like when she is a little cranky and her sister is more annoying to her when she is in that mood. Every little thing that her sister does bothers her when she is feeling that way, even when her sister really isn't doing anything. The foot might feel a little pain even when nothing is really hurting it. It is important to note, "I know it hurts now, but it won't hurt forever." In our family we tend to take a walk or dance or exercise when we are cranky, so they already understand that movement makes them feel better. So I explained how moving the foot may make it a little less cranky faster. It might hurt some at first, just like it might be hard to have fun dancing at first, but eventually it feels better. When we break it down to something they understand they start to feel less scared and it gives them some control over that pain. In pain science, we know that having a sense of control over an injury can really help.
Of course, we all know that just because we tell kids something doesn't necessarily mean they will just believe it. They might still be scared of the pain, that's normal. Adults don't usually get it right away either. So, once I've explained it, we move on with distraction. Distraction is great for pain. Play a game that gets them moving without thinking about it. Dance to a song. Anything you can to let them get their mind off of it. This morning for us it was "Baby Shark". I absolutely hate that song and my daughter knows that. The fact that I let her play it this morning was enough to have her forget about the pain and start dancing. The song ended, we went about her day and she wasn't limping anymore. I didn't bring any more attention to it. I'm sure we will have to go through this again and again over her childhood but eventually it will sink in. And I hope that when she is an adult she will have the tools to help with any pain she is feeling, because we all have pain sometimes. These tools may be the difference that helps acute pain stay acute and not turn to chronic pain.
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