"Mommy, I have a boo-boo."
Q) Dr. Gwenn,
My son often complains about various body aches, particularly at bedtime. I’m torn, 50% of I thinks he’s overdramatizing and looking for attention, the other 50% I wonder if growing bones can get very achy. Is it okay to give a child a dose of Tylenol to cover the possibility he really is aching? I have friends who use colored water or a sugar pill placebo. Are those good strategies?
Thank you for your help,
Katherine
A) Dear Katherine:
This is a common concern among parents. While on the surface, it can appear difficult to discern “pain” in children, true pain doesn't hide and with a little information an intune parent and often hone in on whether the cause of the complaint is medical or more emotional. The ultimate goal is to be sure that real medical pain is not missed but that is just the type of pain an child can not fake. It is real, very uncomfortable and associated with more than just a complaint of "I hurt". Kids in true pain look like they are in pain and are often very upset.
You asked about growing pains. Growing pains are a common cause of true pain in children and can be very uncomfortable. The pains tend to be in the long extremities and occur at night. The typical ages for growing pains are the toddler years and again in the tween years. These pains are real – the child is upset, may be crying, and holding the area in question. These are muscular pains so it is akin to us overusing a muscle during a workout. The lower leg tends to be where the pains are most concentrated and most kids complain. Growing pains do seem to improve by modalities that make all other muscular issues improve: massaging, heat, even medications such as ibuprofen which have some anti-inflammatory properties. Given the description of your son's pain, growing pains certainly sound possible.
For some children, adjunct modalities like distraction can help even with true pain, such as a favorite stuffed animal or security blanket. But, these won’t work long with true pain and don’t work for every child even with attention seeking. If a child is attention seeking, they usually need a parent, not a stuffed creature or blanket.
I'm not a big fan of your friend's approach. I'd suggest you avoid tactics that trick the child into thinking he is getting a medication such as a sugar pill or sugar drink. Either try medicine or do not. You are giving your child the wrong message by using modalities that appear to be medicine that are not if medicine is really not needed. The only way our kids learn to appropriate use medication is to have it appropriate given to them starting in childhood.
Finally, any child that is very uncomfortable or who has persistant complaints should be evaluated by his pediatrician. This is especially important if other symptoms are present such as fever, bruising or inability or reluctance to use that part of the body due to pain. So, take all complaints of "I hurt" seriously until proven otherwise. Your child doesn't need to know you are watching but be sure you do so to not miss the real pain episodes when they do occur. And, remember your pediatrician is a phone call away if needed.
Dr. Gwenn
