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Q&A: Difficulties Managing Response to Pain?


I’m an occupational therapist working with a three-year-old girl. Her permanent caregivers have incredible difficulties managing her response to pain. Before she was placed with them, she developed a severe, nappy, painful rash. Since then, whenever she gets sick or is in pain, she has extreme temper tantrums. They can go on for hours or weeks.

Recently, she had tantrums every day for 3 weeks and couldn’t go to kindergarten. She had a chest infection and chronic constipation, which is continually being treated.  Her tantrums may also result from simple bumps and scrapes. She is learning now to trust her caregivers to help her; however, pain continues to be the one experience that we can’t seem to help her manage.

I’ve included her sensory checklist. Do you have any insights to help with this matter from an OT perspective? Are there any strategies we might adopt to help her respond to pain in a more normal and safe way?

Many thanks for your help.


First, here is an updated copy of our Sensory Symptoms Checklist that includes the eighth sensory system: interoception. This may give you some additional insight. The more I learn about the interoceptive sensory system, the more I think it helps explain some of the issues that often confound me with complicated kiddos.

Second, I suspect this child may be over-responsiveness to interoceptive input, including pain. To learn more about interoception, I recommend Interoception: The Eighth Sensory System by Kelly J. Mahler. It’s available from Amazon. I also have a view-on-demand webinar about interoceptionFor now, try calming vestibular activities when she is in pain. Some examples include slow rocking, lying prone over a ball with gentle back and forth motion, and swinging.

Another consideration is the impact of trauma on the brain. Since she does not live with her birth parents, many recent studies show that separation from parents is perceived as traumatic as well as whatever may have led to the separation). Trauma has some interesting effects on the brain and often leads to unusual responses to pain and difficulty handling big emotions, among other things. If this is the primary variable for this child, I would encourage her caregivers that time and consistency will increase her emotional security. When that happens, the difficulties managing her response to pain will probably diminish. Play therapy or attachment therapy may be helpful with this process as well.

I hope for the best for this child and her family!

Best Wishes,