Babies and toddlers don't have the words to tell you about their pain. But they may show you by doing things such as making faces, kicking their legs, being cranky, crying, or having tense muscles.

To assess pain in babies and toddlers, your healthcare provider may use the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. It uses your child's behaviour to measure their pain.

If your toddler speaks and understands a few words, you can use words they understand ("boo boo" or "ouchie") and ask simple questions like "Does your arm hurt?"

Along with asking a school-aged child about their pain, you and your healthcare provider can use a tool called the Faces Pain Scale – Revised.

This tool shows 6 different faces for your child to choose from. The faces range from a happy face (no pain) to a very upset face (worst pain ever). The face your child chooses helps you understand how much pain they are feeling.

Older children and teens can tell you about their pain. Ask your child to rate their pain from 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine.

You can also use the Stoplight Pain Scale to help you decide what to do about your child's pain:

• Red: "My pain is very bad, and I need help now."
• Yellow: "I may need help for my pain soon—ask me again later."
• Green: "I don't need help with my pain right now."

Children who are non-speaking or have extra cognitive (learning) needs may need to tell you about their pain in their own way. You know your child best and are the best person to measure your child's pain.

Look for any changes in the sounds or facial expressions your child makes, things they do, and anything that seems different with their body.

Healthcare providers may also use a type of Faces, Legs, Activity, Cry, Consolability (FLACC) scale to assess pain in a nonverbal child.

Take your child to a doctor if:

• They have very bad pain and nothing is helping.
• The injury is not getting better or is infected.
• Their illness is not getting better with treatment.

Pain from many minor injuries and mild illnesses can be managed at home. For some injuries, you can use an ice pack on the area to help your child feel better and have less pain. After a few days of ice, using a heat pack can help with pain from muscle spasms.

You can wrap injuries such as strains or sprains.

If skin is wounded, such as with a cut, scrape, burn, or scratch, carefully wash the area to clean out any dirt or debris. Then cover it with a bandage, which can help with pain.

If your child has pain from an illness, such as a sore throat, talk to your healthcare provider about ways to manage their pain.

If your child is having a medical procedure, such as a blood test or stitches, there are ways you can help them be calm and have less pain.

For babies:

• Breastfeed your baby during the procedure.
• Offer your baby a pacifier (if they use one) during the procedure.
• Give oral sucrose (sugar) or sucrose drops to your baby just before and during a medical procedure. The sweet taste sends signals to the brain to reduce pain. Sucrose drops are only for medical procedures—never use sucrose drops at home to calm a crying baby.

If your toddler or older child is having a procedure, you can hold them in a comfort position. There are different comfort positions that you can use depending on your child's age and what procedure they are having. Ask your healthcare provider what position to try.

Routine immunizations (vaccines) can also cause stress and pain. There are many things you can do to help your child during immunization to make it a better experience.

Children can get very upset when they have acute pain. There are ways to help your child calm down, feel less afraid, and stop focusing on the pain.

Breathing
Help your child focus on their breathing. Teach them belly breathing with easy, slow, deep breaths in and out. Do the breathing together.

Distraction
Distraction techniques can help to move your child's attention away from their pain. For babies and toddlers, distraction ideas can include singing and talking or using things such as toys, pictures books, or bubbles. You can bring your own or ask your healthcare provider if the clinic or hospital offers any.

For school-aged children and teens, you can use books, videos, or video games as distraction. Mind exercises (such as counting back from 100), talking about favourite memories, or focusing on an object can also help distract your child from their pain.

Guided imagery
Older children can try guided imagery to redirect their attention away from pain. Help them use their imagination to see pleasant and calming pictures in their mind, using as many senses as possible.

You can use guided imagery along with other relaxation techniques, such as muscle relaxation, to help your child.

Non-prescription
Over-the-counter pain medicines (medicine you can buy without a prescription from a doctor) can help with acute pain in the short term. They can help with fever, swelling, aches, and pains. These medicines include acetaminophen (such as Tylenol) and ibuprofen (such as Advil or Motrin). Always follow the directions on the package and ask your pharmacist if you aren't sure what medicine to give your child or how much to give them.

Some children find it hard to take medicines. You can try these tips to help your child take medicine.

Prescription
If your child has an infection caused by bacteria, your doctor might prescribe other medicines, such as antibiotics, to help fight the cause and stop the pain. Make sure your child takes all their medicine the way the doctor or pharmacist told you.

Short-acting opioids
Broken bones and emergency problems like appendicitis can be very painful. Some treatments, like changing a burn dressing, can also cause pain.

For medium to very bad pain, short-acting opioids may be added to your child's care plan. Examples of opioids are morphine, fentanyl, and oxycodone.

Your doctor will talk to you about any risks and benefits of opioids. They can be safe for children when you give the right doses the right way.

You can do many things to help your child's acute pain from injury, illness, or medical procedures.

Pain from illness or injury
Acute pain from injuries and illnesses is common in children. You can protect your child by:

• Teaching your child correct handwashing.
• Making sure your child wears the right helmet when they ride their bike, scooter, or skateboard.
• Using gates ​at the ends of stairs for babies and toddlers.
• Watching them while they play.

See a doctor for emergencies and any questions about how to manage your child's pain.

Learn more about preventing injuries in children:

• Backyard safety for children
• Keeping your toddler and preschooler safe from falls
• Preventing burns
• Sport and recreation safety for children​

Pain from medical procedures
When your child is having a medical procedure, it's important to stop pain before it starts. There are different things you can try, depending on your child's age and the procedure they are having:

• Topical anesthetic cream, also called numbing cream, numbs your child's skin so they feel less pain for a procedure like a blood test or stitches. There are many different kinds. Ask your pharmacist, nurse, or doctor what might work and how to use it.
• Vapo-coolant freezing sprays can sometimes be helpful for short procedures such as getting a vaccine. They are not as well studied as numbing creams.
• Lubricant gels with lidocaine can help for procedures such as bladder catheterization or nasogastric tube insertion.
• Your healthcare provider may use nitrous oxide, or laughing gas, if your child has a lot of anxiety or stress about a procedure. It's easy to give and starts working quickly.
• You can ask your healthcare team to do tests together or do more than 1 procedure at the same time, so your child has less pain and stress overall.

Ask your child's healthcare team about how to prevent pain during a procedure.​​​​​

When acute pain transitions to chronic pain, physiotherapy can help. A physiotherapist can guide your child about how to safely become stronger and more flexible.

Physiotherapy may include exercises, hands-on treatment of the sore areas, ice or heat, and electrical stimulation.

Massage therapy may also help with your child's transitional pain. It can also lower stress and help your child relax.

Transitional pain can make your child feel angry, sad, or hopeless. A mental health professional—such as a trained counsellor, registered psychologist, or psychiatrist—can work with your child to help them cope and manage their feelings. When your child is coping well, they may have less pain.

Mental health treatments may include:

• Cognitive behavioural therapy – helps your child find unhelpful thinking and behaviour patterns and learn healthier ways to cope.
• Acceptance and commitment therapy – teaches your child how to accept their pain and take action by setting goals.
• Relaxation training – helps your child to relax deeply, which can lessen pain.
• Stress management – shows your child how thoughts can affect stress and how to look at tough situations in a healthier way.

Depending on the stage of transitional pain, medicines such as ibuprofen or acetaminophen may help to treat pain.

Other medicines that are not normally prescribed for pain, such as anticonvulsants and antidepressants, may also be prescribed for long-term chronic pain.

Opioids aren't usually a good choice for most types of transitional and chronic pain. Taking opioids for a long time can cause harmful side effects in children.

Physical treatment for your child's chronic pain may include:

• Physiotherapy – uses regular exercise and movement (such as jumping, walking, or other exercises) to help your child get stronger, more flexible, and have better endurance (they can play and exercise longer). Having a stronger body helps your child move better and have less pain. A physiotherapist may give your child an exercise program to do at home.
• Occupational therapy – builds fine motor skills and coordination to help your child do everyday tasks (such as getting dressed and brushing their teeth) on their own.
• Activity pacing – this means planning activities around how your child is feeling and making sure they are getting enough rest. Children with chronic pain can live active and healthy lives. Sometimes, you just need to change the length or type of activity to better suit them.

A healthy and calm mind can help your child feel better in their body. How your child thinks about their chronic pain is an important part of treatment. Stress, worry, and negative thoughts can make pain worse.

Mental health treatments for chronic pain may include:

• Relaxation therapy – helps your child manage their feelings, calm their mind, and have less pain. Feeling stressed or angry can make your child's pain worse. An example of relaxation therapy is progressive muscle relaxation, which works by tensing and relaxing the muscles again and again.
• Cognitive-behavioural therapy – helps your child find unhelpful thinking and behaviour patterns and learn healthier ways to cope. It helps to change bad thoughts about pain into more positive thoughts, helping your child to feel better.
• Mindfulness exercises and yoga - combines mindfulness with moving your body. It teaches your child to focus on the present moment and where they have pain.
• Biofeedback – this training helps your child control things their body does automatically. It shows them information about their breathing, muscles, skin, and heart, so they can understand their body and manage their pain.​​

Every child's chronic pain is different, and not all medicines will work for every child. Ask your doctor if medicine can help your child's pain. When you give your child medicine, always follow the instructions on the package and talk to your pharmacist if you have questions.

Some children find it hard to take medicines. You can try these tips to help your child take medicine.

Medicines for treating chronic pain may include:

• non-steroidal anti-inflammatory drugs
• acetaminophen
• medicines that treat other conditions, like some seizure or depression medicines

Opioids can cause harmful side effects if used for a long time. They are almost never given to children with chronic pain.