The Challenge of Managing Other People’s Pain

Doctors with children, maybe especially pediatricians with children, fall along a spectrum, or maybe it would be truer to say, oscillate between two poles when it comes to how seriously we take our own children’s complaints. On the one hand, we can sum up a child’s minor illness with a certain jaded well-I’ve-certainly-seen-worse shrug; so you have a headache, go lie down in a dark room.

But like all doctors, I know too much, and sometimes that can send you in the other direction. My youngest child once woke up saying his stomach was hurting. He had pain in the classic place where the appendix often attaches, he was demonstrating textbook symptoms of appendicitis. I had him so firmly diagnosed that nothing could dissuade me. As it turned out, he didn’t actually have appendicitis, he just had a good story for it, as we say.

That’s the oscillation I mean; when it comes to my own children, I tend to start with total denial: it’s nothing serious, don’t exaggerate, don’t make a fuss. But then a little switch flips, and I jump right from suggesting a cold cloth on the forehead for a headache to being certain I’ve missed diagnosing meningitis and we urgently need a spinal tap.

And that in part reflects certain specific pain codes that can freak me out, with my own children, with the children of friends, and with patients. With children, after all, it’s fine to be pretty relaxed about chest pain, most of the time (adolescents with chest pain always think they’re having heart attacks, goes the pediatric wisdom, but they generally aren’t), but we pay a lot of attention if a younger child seems to have hip pain because infants and young children can develop rare — but serious — hip infections.

There’s groin pain in a boy that can mean a pulled muscle or a too-small athletic cup, and there’s groin pain in a boy that can be a sign of testicular torsion, a medical emergency. And mixed in with all the headaches and stomach aches of childhood, there are those constant pediatric threats, the headache which is meningitis, the stomach ache which is appendicitis.


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