Every child experiences physical pain (a broken arm or a nasty infection). During this time their development goes on standby until they recover… but what about children who deal with pain that lasts an extended period of time and impacts their growth and development?

Chronic pain in the classroom is a difficult area to find adequate solutions for. In my early career I worked as a tutor for young adults with various disabilities, I now have a much more personal experience of children dealing with chronic pain.

My oldest daughter suffers from arthritis. Sometimes she is fine (she can run races, climb monkey bars and swim like a fish) but other times it is painful and can prevent her from simply walking. Surprisingly it is not the physical limitations that are her primary challenge, it is her social and emotional development that suffers the most due to this largely invisible physical condition

New medication means that even during her ‘flair ups’ she has missed very few days of school due to mobility. But the underlying constant pain that effects her during a ‘flair up’ takes its toll on her ability to regulate her emotions. My best explanation is that it’s similar to an adult having a migraine and continuing work. Your workmates who don’t know your plight will probably wonder why you are so grumpy and vague, even though you have the coping strategies of an adult.

When Anica has a flair up her learning stops. She can’t focus, she doesn’t listen, she overreacts to the slightest challenge. In our house a 6yo who is obnoxious and obstructive all morning is often a 6yo who is in pain, though sometimes she just behaves like this because she is 6. It is too easy to miss the signs and hold the child responsible for their unreasonable behaviour.

When I see her pain I medicate her and warn her teachers to watch for behavior changes through the day as a sign to give her additional medication. But when I leave her in class her eyes are still glazed over, she’s vague, and easily brought to tears. She forgets her basic routine and doesn’t seem to hear instructions.

Fortunately Anica is developing at an acceptable rate, she is not being left behind academically and her social and emotional coping strategies are improving. Here’s how we have supported her through these challenges:

Class teachers need to be informed of specific traits to the individual child. 

We’ve had a teacher who would not medicate Anica (because she was still moving and playing fine) but in the next sentence complained about her attitude. This showed we had not explained the symptoms clearly enough. This teacher was basing her understanding of pain management on her own experiences, not fully hearing the differences in Anicas condition. Once medicated Anica’s attitude problems disappeared. I ensured that the new teacher was given a thorough written explanation specific to Anicas condition and this has had a very positive result for us; Anica is fully supported at school and her learning is benefiting from this.

Not everyone will be able to support the child, and that is OK.

I’ve seen my Daughter run to the duty teacher in floods of tears because of something as trivial as not being given her turn in the playground, and know that will be subconsciously noted as a personality trait rather than an emotional symptom of a physical condition. You can inform the key people in the child’s education, but you can’t pin a diagnosis to the child’s shirt and ensure everyone knows why they’re behaving that way. It is helpful that key people know so they can provide additional support but the people who don’t understand also provide a lesson (a harder lesson, but with enough key support she should be able to work through those challenges and become a stronger person capable of surviving the similar judgment that she will have as the condition effects her later in life.)

The condition will shape the child, and that is OK too

She is a child, her identity is developing, the reactions that people have to her impact her developing brain. The way she reacts due to her condition, and the way people treat her are actually forming her identity. This is something that concerns me; I see her brain wiring in a protective hesitation to try new things, I see her overreacting (in pain) and know this will also form a basis for how she deals with situations when she is well (neurons that fire together wire together etc). These are normal concerns of a parent watching their child change, but Anica has taught me that, while this is a challenge for her, her Arthritis is part of her identity.

Last week Anica was irrationally concerned when I gave her a vitamin C, because she was scared this ‘new medicine’ would take the Arthritis away. As an adult it is difficult to accept that your child is so attached to an illness, but she does not see it that way. “It has taught me to be good with needles, and things like that” was her explanation. These are challenges for Anica now, but they will transform into skills in adult life. Instead of skipping freely through life she has been dealt a set of metaphorical weights to carry along the way, but as she grows those weights will make her stronger.

The condition will impact, but not determine, what the child can do.

It is hard to do some things when a child is ill, especially if that illness causes pain. Imagine attempting a bush walk with your grumpy tired offspring who has the flue. (It doesn’t sound like it will be fun, does it!) If your child has the flu, stay at home and read a book. But if the child is constantly tired and sore, pick a good day with support and go on a bush walk regardless. (Be prepared for a disaster, have an exit route, and be pleasantly surprised if it is not a catastrophe.) It is important that there are still opportunities for development and exploration, even if they are fewer and further between than when the child is healthy.

Motivation and comprehension during illness will be reduced.

This brings me to my final aspect of teaching a child who is in pain regularly. When you are in pain you cannot learn as easily. Today my daughters glazed eyes stare at the page of words that she world otherwise read with ease, her inquisitive nature subsides, her enthusiasm diminishes. I continue to teach and talk and share as I normally would but I also try not to push her beyond her reduced capabilities when she is in pain (experiencing repeated failure at something you can usually do is not something I want to subject her to in quantity).

I find that she often has a burst of learning shortly after a period of pain. I do not know if this learning is a result of what we worked though during her pain (having been subconsciously stored until her mind was capable of processing the information) or if it is coincidental (as even well children don’t learn at a steady predictable pace).

From my personal experiences I have learnt that sometimes chronic pain in the classroom is best dealt with as you would a learning disability, rather than a physical disability. While it is a physical condition (and you need to allow for this) as a teacher you will not be able to offer enough physical support to alleviate the symptoms, instead you are better offering the child additional help to conquer the aspects of learning that are made difficult for the child by that condition. Just as a child who is dyslexic might need additional support to learn to read, a child who suffers chronic pain might need additional support to learn how to regulate their emotions and focus when they are in pain.

Being in pain is truly horrid, I witness this in my own child, but with the right support that pain can form the basis for a stronger and more capable adult. I watched my childhood friend (who also suffered Juvenile Arthritis) grow into one of the bravest women I have met. I can see the early stages of a brave young woman in my fragile 6yo girl. At just 6yo she has decided that she is the master of her own wounds and will dress, disinfect and clean even the most garish wound without hesitation (we are permitted to hand her dressings, but certainly not to touch her!) She is taking control of her pain, and one day tells me she will be a doctor like all the people she sees at the hospital…

Or maybe a pilot…

Or perhaps a hairdresser…

She remains healthily undecided on that one.

(Anica and her 6yo ‘co-stars’ after they had finished filming a commercial for Arthritis & Osteoporosis Tasmania. Arthritis & Osteoporosis Tasmania provide programs and services to support people with arthritis, osteoporosis and related conditions.)