I continue to hear health-care professionals and parents referring to “psychological” pain. People are forever pointing their fingers at this pesky, imaginary perpetrator that allegedly causes children to yell, flail, and physically resist the tiniest needle stick.
This idea of a separate, psychological pain is not quite accurate, according to the latest pain theories. The pain-sensing system can be influenced by cognitive, emotional, behavioral, and contextual variables. This means that the same child, experiencing the same amount of tissue damage, on the same area of the skin, is likely to report different levels of pain depending on factors such as how anxious he is, the setting in which he experiences the painful stimuli, and his understanding of what is happening. Yes, there is a psychological component to pain, but it often causes actual changes in pain perception.
The concept that pain perception is influenced by external factors is far less grim than the idea that the intensity of pain is strictly related to the amount of tissue damage, because it implies that there is an opportunity to reduce pain by changing the variables that influence it.
Helping children cope better
Children are resilient beings, and eventually, most learn to cope well with the routine of diabetes management. Health-care providers and parents can facilitate coping for young children with the following tips.
Acknowledge your child’s fears. Understand that injections and fingersticks may be scary to children and that kids may experience real discomfort. Refrain from telling your child that his claims of discomfort from shots or fingersticks are wrong. Responses such as “You didn’t feel that” can be embarrassing and frustrating if the child truly did experience pain. A more helpful response to a child who says, “That really hurt!” might be, “I can tell you had some pain. Let’s try and find a way to make it easier next time.”
Reduce anxiety-provoking factors. Because some children may be less apprehensive if needles are hidden, families may want to try using an injecting device such as the Inject-Ease, made by BD, which encases the syringe and needle. Be aware, however, that the device may have the opposite effect on children who dislike large injection devices.
Provide your child with one minute of preparation time per year of age for injections or fingersticks rather than abruptly interrupting his activity. For example, if your child is three years old, give him a cue three minutes before injection; if he is five years old, give the cue five minutes prior.
Adults should try to remain as relaxed as possible. Children are greatly influenced by parental anxiety. Talk softly and slowly. Try not to escalate the tone or speed of your speech if your child begins to cry or resist.
Everyone involved in blood glucose monitoring or injecting insulin may want to practice controlled breathing. Instruct your child to take a deep, slow breath, hold for three seconds, and exhale slowly. Do this two to three times together. Time the insulin injections with the last breath, and have your child blow out as the needle is being inserted, as if he were blowing away the pinch.
When possible, find a quiet place to do injections. In the home, families may want to choose one area of the house to do most injections. This may help the child feel less anxious by setting a clear, physical boundary for where injections happen. If using one area of the home is not possible, then try to pick at least one area to be a “safe zone” where injections never occur.
Make a schedule. Using a doll or child-friendly chart, create a rotation schedule that your child can understand easily. Families can mark the appropriate injection sites on a cloth or vinyl doll and then write the day and time insulin injections are due in that site. Some children may prefer a simple calendar chart with days, times, and sites written out. Either type of schedule will provide a clear sense of where injections will go and when they will happen, reassuring the child that diabetes care is part of a routine and not a punishment for something he did.