It’s just after midnight. The child is crying inconsolably and clutching their tummy. Their forehead is hot, their eyes swollen.

At times like this, parents often feel helpless: what’s wrong, what’s my child suffering from? Do I need to go to A&E?

Or will a hot water bottle, pain-relief suppositories and plenty of comfort and encouraging words suffice?

Pain in children is one of the biggest challenges for mums and dads. Not least because the little ones often cannot even say or describe what is wrong with them. 

Pain is not an enemy, but a friend 

So how do you explain to a child what an “ouch” is? This is the best way: pain is not a threat, but a protective mechanism.

It is the body’s way of telling us that something is poorly or injured and needs attention. How intensely someone feels pain is highly individual.

Parents should therefore never play down their child’s experience of pain. Because it is not just about where the pain comes from, but also about what it means to the child.

For example, anyone who fears that something serious lies behind the pain will feel it more intensely.

An important life lesson to pass on is that pain is an inevitable part of life and it passes. Incidentally, people who have no sense of pain from birth live dangerously, because they simply do not notice injuries. 

Even in the womb 

Unborn babies can feel pain from as early as the 24th week of pregnancy.

This relatively recent discovery has fundamentally changed neonatal medicine.

Until the 1980s, it was assumed that newborns and infants were hardly sensitive to pain due to immature nerve pathways. It was also long believed that young children would quickly forget pain. Both assumptions are incorrect.

Like adults, babies have ascending pain fibres that transmit signals to the brain. There are also descending nerve pathways through which the brain sends pain-inhibiting neurotransmitters.

In infants, however, these descending pathways do not fully mature until around the fourth week of life, so their bodies are actually less able to regulate pain themselves.

That is why particular care is now taken to ensure appropriate pain relief for premature babies. 

How much does it really hurt? 

It is sometimes a real detective job to work this out. Yet even babies give clues: they might touch a sore ear or instinctively adopt a protective posture. 

Parents can learn to gauge their child’s condition through careful observation. Body posture, the type of crying – whether plaintive or more protesting – and muscle tension often reveal more than words.

Parents should be particularly alert if a toddler suddenly stops what they are doing and cannot be calmed by anything. For older children, a simple pain scale has proven useful: from 0 (“doesn’t hurt at all”) to 10 (“really hurts”). 

When is a painkiller appropriate? 

Where the symptoms are not clear, parents can first observe whether attention, rest, a hot water bottle, tea or an audiobook provide relief.

However, in the case of injuries or a painful illness, a painkiller may well be appropriate. It is important to follow the dosage instructions exactly. 

Different active ingredients and dosage forms, such as syrups or suppositories, may be suitable depending on the child’s age, weight and the nature of the symptoms.

It is important to be aware that the active ingredient ibuprofen is only approved for babies aged three months and older.

Concerns that paracetamol could trigger eczema in babies have been dispelled by the results of a recent study. Parents can seek individual advice at the chemist’s. 

Tummy ache: The great mystery 

Tummy ache can be anything or nothing at all. Parents should therefore first pay attention to the child’s general condition and observe. Can the child possibly pinpoint the pain more precisely? Are they easily distracted and do they then forget the discomfort?

The problem with tummy ache is that younger children often cannot yet find the right words to describe exactly what is hurting.

However, they often learn the word “tummy” very early on and frequently use it as a catch-all term for anything that aches anywhere in the torso.

A practical tip for parents: if your child has a tummy ache, do check their throat as well, as a sore throat is often the underlying cause.

If the crying persists, the tummy feels tense, or there are other symptoms such as chills or bloody stools, it is important to refer to a paediatrician immediately.