Pain is an unpleasant experience connected to irritation of the body. Best understood as what a person says 'hurts,' pain is different for everyone. Many factors, including culture and past experience can affect how we cope with pain.

Pain can be acute (such as a headache, toothache, or stomach ache) or chronic (such as arthritis pain, and pain associated with cancer.) Acute pain can protect us, warning that something is wrong. With it there can be a rise in blood pressure and heart rate, and sweating. Chronic pain can cause anxiety, irritability, loss of appetite and sleep, and can have a major impact on the quality of life.

Recent studies dispute the theory that younger children are less likely to feel pain because their central nervous system is not fully developed. All children react to pain; how they react is based on their stage of development. Older children remember painful experiences and so respond to acute pain differently than younger children. This is because the present suffering reminds them of previous discomfort and unpleasant results.

Pain in children should be treated promptly, both with drug and non-drug measures. Along with the pain, children can also feel anxiety that calls for special attention.

How to manage pain

See a doctor if your child has:

Severe or continual pain
Severe earache
A throbbing, very painful headache
Abdominal or chest pain
Pain passing urine
Pain associated with redness and/or swelling
Pain that interferes with normal daily function
Pain that significantly impairs a child from their usual behaviour
Pain associated with mental confusion or loss of alertness
Other minor pain that lasts longer than five days.

Non-drug measures

Try relaxation, rest and fresh air for mild to moderate headaches
Use the RICE method for muscle strains and sprains: R= rest, I=ice (for the first 48 hours, then use heat), C=compression, E=elevation
Gently massage a painful muscle
Keep your child’s mind off the pain by playing or reading.

Over-the-counter (OTC) drug treatment

In children, most mild to moderate pain responds well to acetaminophen or ibuprofen. Ibuprofen also helps to reduce inflammation and may help muscle pain, toothache or menstrual symptoms in teenage girls.

Fever

Fever is an increase in body temperature in reaction to something abnormal happening in the body. The average body temperature is 37°C (98.6°F). However, it varies during the day between 36.5°C (97.7°F) in the morning and 37.5°C (99.5°F) in the late afternoon. These changes are greater in children than in adults. Most often fever is caused by infection but other conditions, such as diseases with inflammation and some forms of cancer can also raise body temperature.

Fevers may cause dehydration, lack of energy, weakness and muscle pains. However, fevers are usually not harmful. Fever is the body’s warning sign that something is wrong. Therefore, a mild fever with an illness such as a cold, or with a bacterial infection may not require fever medication. The goal should be to treat the illness causing the fever, rather than the fever itself.

Although fever rarely causes serious harmful effects in children, many parents fear it will cause brain damage. Fever by itself is not dangerous and will not cause brain damage. In fact, fever in children rarely exceeds 42°C unless there is a serious medical condition present as well.

Fever has to be distinguished from hyperthermia. It can occur with exercise and being in a hot place such as when a child’s room is too hot, or a child is overdressed. If kept too warm, babies and young children can have skin problems and become dehydrated. Medicines that reduce fever should not be used for hyperthermia. Instead, the child can be uncovered or wrapped in damp towels and the room moderately ventilated.

Why treat a fever?

Mild fevers in children are usually caused by respiratory tract infections. A mild fever can be associated with chills, dehydration, headache, loss of appetite, nausea and vomiting. The age of the child, together with the extent of the temperature increase, can indicate the risk of serious infection.

Infants less than three months of age may not show the usual signs and symptoms of disease, such as fever or inflammation. Therefore, children in this age group with a temperature over 38°C (100.4°F) should be seen by a doctor. A child six months of age or older, with a temperature over 39°C (102.2°F), could have a serious bacterial infection and should be seen by a doctor.

Many parents are concerned about febrile (fever) seizures happening to their child. Febrile seizure occurs in two to five per cent of children three months to five years of age. However, it rarely results in nervous system damage or ongoing problems with seizures.

It is still not certain whether the rate at which the body temperature rises is more important than the actual temperature reached, in causing a seizure in a child. Febrile seizure is more common with temperatures over 40˚C. However, a child inclined to have seizures may have one with only a moderate rise in temperature. These seizures often occur at the start of a fever, showing that an infection is present.

After an immunization a child may have redness and pain at the injection site, lack of energy, headache and mild fever. Giving a fever and pain-reducing medication at the time of immunization can reduce the risk of fever and pain.

How to manage a fever

See a doctor if your child has a fever and:

is less than three months old
has a stiff neck or seizures
appears very ill or is crying and cannot be soothed
has any serious disease
is excessively sleepy or confused
the fever is above 39°C (102°F)
it lasts more than one day without an obvious cause.
it lasts more than three days

Non-drug measures

Light clothing and a light cover are best for a child with a fever. For higher fevers, sponge your child with tepid water. In warm weather, direct an electric fan over the child. Do not let your child get chilled. Rubbing alcohol should never be used for cooling. It is very important to give your child plenty to drink to prevent dehydration. Sleep also helps recovery.

OTC drug treatment

The two OTC medications used for reducing fever in children are acetaminophen and ibuprofen. These medications may not lower the temperature to normal and do not prevent the fever from coming back. Do not alternate ibuprofen and acetaminophen. Talk with a doctor before using the medication in infants less than four months old. Keep all medications out of reach of children.

Use medication if a fever is above 39˚C and the child is uncomfortable (unless the doctor suggests otherwise). Do not focus on how high the fever is, but on the comfort of the child. Do not wake a sleeping child to give fever medicine.

The medication can be given again without rechecking the temperature, unless the child is uncomfortable even with treatment or feels very hot. Then you will need to recheck to see if the fever is getting higher. Do not exceed the recommended dose or give the medication more than five times in a 24-hour period. Do not use the medication for more than three days, without talking with a doctor.

Do not give acetylsalicylic acid (ASA or aspirin) to children and teens due to its strong link with Reye’s syndrome in viral infections such as influenza and chickenpox.

Methods of measuring body temperature

Body temperature can be measured via the ear, mouth (orally), underarm (axillary) or rectum (rectally). Rectal temperatures are about 0.6°C higher, and underarm temperatures are 0.5° lower than body temperaures measured by mouth. Oral temperature will be less accurate if the child has had something to eat or drink during the last half hour, or is breathing through their mouth. It is important to keep the lips tightly closed and hold the tongue down on the thermometer.

Since this can be difficult for a child, the oral route is recommended mainly for older children. In younger children, under the arm is the easiest place to take a temperature. Rectal temperature is most accurate, but can be uncomfortable and frightening for small children and so is not recommended for routine use.

Tips for measuring body temperature

Shake a glass thermometer sharply before use to ensure that the mercury column is below about 35°C (95°F).
Handle glass thermometers with care as they break easily. Do not use them near excessive heat.
Hold an electronic thermometer in place for at least one minute before reading the temperature. Glass thermometers need five minutes.
If using the rectal route, lubricate the thermometer and anus with petroleum jelly first. Be gentle and reassuring while inserting it two to three centimetres into the rectum. Hold it in place for one to five minutes, depending on the type of thermometer.

Acetaminophen (Tylenol™, Abenol™ suppositories, Tempra™)

Acetaminophen is effective for most types of pain and fever. The recommended amount is 10 to 15 mg/kg per dose every four to six hours, not more than five times a day. It starts to work within one half to one hour, and its effect lasts four to six hours. Acetaminophen usually does not have significant side effects. However, with overdose or long-term use of high doses, it can lead to liver damage. Talk to your doctor or pharmacist if your child has a kidney or liver problem. Acetaminophen comes as liquid, chewable tablets, suppositories, tablets and caplets.

Ibuprofen (Advil™, Motrin IB™)

Ibuprofen works for fever, pain and inflammation. In children it is used for fever and pain due to colds, sore throat, immunization and earache. It can also be used for temporary relief of mild to moderate pain with headaches, aches and pain in muscles, bones and joints. It is very good for menstrual and dental pain. The recommended amount in children is 5-10 mg/kg per dose every six to eight hours. For dosage instructions please consult your pharmacist.

The most common problem with ibuprofen is stomach upsets. It can infrequently cause nausea, vomiting, diarrhea, constipation, bloating, heartburn, bleeding ulcers, ringing in the ear, rash and itching. If your child has any of these effects, stop giving the medication immediately and talk to your doctor. To lessen these effects, give the medicine with food or milk. It is not to be taken on an empty stomach. Do not use it for a long time to manage conditions such as joint or muscle pain and swelling unless supervised by a doctor. Talk to your doctor before using ibuprofen if your child is allergic to ASA, has liver or kidney problems, asthma, a nasal polyp, a blood-clotting disorder, or an ulcer. Ibuprofen comes as liquid, tablets and caplets.

Acetylsalicylic acid – ASA (Aspirin™)

ASA reduces fever, pain, and inflammation. It is not recommended for children and teens due to its strong link with Reye’s syndrome in viral infections such as influenza and chickenpox.

Caring for a child with pain or fever can be demanding. This article provides some guidelines. Your pharmacist is available to talk with you about non-prescription drugs for managing your child’s pain and fever. Check with your doctor if you have any questions or concerns about your child’s illness and its treatment.