It is so heartbreaking to witness infant or toddler pain. When they are young and unable to communicate so well, it can be hard to know if child pain is serious or not. This page will help you decide what to do when your infant or toddler has pain.

To find about medications for pain in babies and toddlers, click here.

For babies, the usual indication of pain is that they cry and that can be harder to interpret. Crying in an infant can be for so many different reasons that you need a strategy to follow to determine if the crying is due to pain or some other discomfort. See the crying page for more information on this.

For toddlers, it can be easier to pinpoint the pain. Young children may complain of a "sore tummy" or "sore head" so you have an idea of what the problem is.

On the infant and toddler pain page, there are sections on:

Toddlers often complain of abdominal pain. It may be associated with other features including:

• nausea
• vomiting
• diarrhea
• constipation
• pale face
• waking at night

When the abdominal pain is located in the center of the abdomen around the umbilicus and doesn't cause any other symptoms, we call it non-specific abdominal pain (also known as functional abdominal pain) and it usually isn't that serious. This is a common complaint in toddler pain and although your toddler may briefly seem upset, the pain quickly disappears or, at least, is not severe enough to interfere with your toddler playing.

Another common cause of abdominal pain in children is constipation. Even if you think your child is going to the toilet regularly, she may not be completely emptying her bowels. You may need to check after she's been to the toilet.

Just as children can get enlarged glands in the neck with a viral infection, they can also get enlarged lymph glands around the outside of the gut. This is called mesenteric adenitis and can cause tummy pain in children. There is no specific treatment - it gets better as your child gets over the infection. Paracetamol or Acetaminophen can be given for pain relief.

If your toddler looks pale with episodes of abdominal pain and has nausea and/or vomiting, then she may have abdominal migraine. Looking for trigger factors might help in preventing attacks - the migraine headache page has more information on looking for trigger factors.

Abdominal pain that occurs after eating gluten-containing foods, such as bread, may indicate celiac disease, which is gluten intolerance. Diagnosis is by small bowel biopsy but blood tests can strongly suggest its presence (particularly a high tTG test or a positive EMA test).

Toddler pain in the lower abdomen associated with frequent urination or pain on passing urine (we call this dysuria) can be a sign of a urinary tract infection. A urine test will confirm this and the treatment is antibiotics.

Abdominal pain due to surgical conditions, such as:

• intussusception
• bowel obstruction
• strangulated inguinal hernia
• appendicitis

is often associated with vomiting.

See your doctor if your infant or toddler has abdominal pain and any of the following:

• vomiting, especially if it is bile-stained vomit (bright green vomit)
• pain that is not central in the abdomen
• a mass that you can feel in the abdomen
• poop (poo) that looks like red-currant jelly
• your child is losing weight
• your child is peeing frequently or complaining of pain on passing urine
• your child has severe abdominal pain that is worse going over bumps in the car - it could be peritonitis
• you are worried your child isn't well

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Yes, babies and toddlers can get headache and it can be a serious cause of infant and toddler pain. When a child has a headache, there is always the concern that there is some pressure in the brain causing the headache.

Conditions that can cause headache in infants and toddlers include:

• brain tumors - often the headache is worse in the morning and can be associated with vomiting. Imaging of the brain with a CT or MRI scan can usually make the diagnosis.
• hydrocephalus - also known as water on the brain. Children can have blockages in the normal channels that drain the fluid from around the brain which can cause water (or actually cerebrospinal fluid or csf - it looks watery) to accumulate in the brain. There are usually other signs as well and imaging with CT or MRI scans make the diagnosis.
• infections, such as meningitis - children with meningitis will be ill and if they are older than 18 months of age, they often have a stiff neck. Diagnosis is made on lumbar puncture.
• migraine headache - these can occur in young children. They can be one-sided and are often associated with a pale face, nausea and vomiting. I would want to be sure that other causes of headache had been excluded before attributing toddler pain to migraine headache and so I would probably want to perform imaging studies like CT or MRI.

Sometimes it can be hard to know if your infant or toddler has a headache - read about signs of headache in a toddler.

See your doctor if your infant or toddler has a headache and any of the following:

• she has vomiting, especially in the morning
• she is unsteady on her feet
• she can no longer perform tasks she had previously mastered
• she looks unwell
• she has a stiff neck
• she seems drowsy and less alert than normal when she is awake
• you are worried your child isn't well

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Children often complain of:

• earache
• sore throat

Pain in the neck can be because the lymph nodes in the neck are enlarged.

See your doctor if your child has head or neck pain and any of the following:

• fever and a stiff neck
• headache
• you are worried about your child

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Toddlers often wake at night complaining of leg pain. Your toddler can be quite distressed. Massage can often help. If the next day, your toddler is running around and not complaining of pain or limping - this is probably what we refer to as growing pains.

Growing pains, despite the name, are not caused by growing though - read more.

Causes of leg pain in your toddler or infant that require medical attention include:

• osteomyelitis - the leg will have an exquisitely tender spot and there may be a limp and a fever. Your toddler's symptoms won't disappear.
• leukemia - this can present with bone pain. Your child will probably have other symptoms, such as looking pale or bruising easily. This type of infant or toddler pain is more likely to be there all the time than come and go.
• Perthe's disease - this is a condition where the rounded head of the femur becomes flat. Your child will probably be limping although may not complain of too much pain.
• fracture - you would usually be aware of some trauma causing this. This infant or toddler pain would usually be associated with lack of movement, tenderness to touch and extreme pain on movement.

See your doctor if the leg is the site of your infant or toddler's pain and any of the following:

• limp
• fever
• looks pale or is bruising easily
• is very tired and listless
• there is swelling of any joint
• you are worried about your child

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Young children can get muscle and joint pains. Some viral infections cause aches and pains in the muscles and can cause a reactive arthritis (swelling of the joint) - this is usually transient and resolves by itself. The only treatment may be Ibuprofen to control the toddler pain and inflammation.

Young children can also get chronic arthritis - it is called juvenile idiopathic arthritis - the idiopathic means we don't know what causes it. There are many medications available to keep the arthritis under control and prevent any long-term damage to the joints in these children. Toddlers may not complain of much pain despite having active arthritis with swelling of the joint.

Children can also get infection in the joint - septic arthritis. This makes the joint swollen and very painful to move. Antibiotics are required, initially intravenously. The joint also needs to be washed out surgically.

There are also other childhood conditions that can cause joint pain including:

• Henoch Schonlein Purpura (HSP)
• Kawasaki disease

See your doctor if your child has muscle and joint pain and any of the following:

• swollen or hot joint
• very painful joint
• limp
• difficulty climbing stairs or getting up from the floor
• fever for more than 5 days
• rash
• you are worried about your child

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