"It's all in your head" | How to Recognize the Impact of the Medical System on Your Child with Chronic Pain

When children and teens (and adults!) have invisible illnesses that are subjective, such as chronic pain, it can be difficult for them to describe it to doctors. Kids will use all sorts of creative descriptions for their pain, such as, “It feels like a cold metal pole is inside my leg, and ice is clanking through it.”

Physicians are not trained to understand this type of language or to view the child as a “whole child” influenced by biology, emotions, and the environment. When there is a problem that doctors cannot see on imaging, in laboratory tests, or with a scope, they often feel stumped. That can lead to feeling anxious about how they are going to “fix” their patient. This impatience with their patients can lead to harmful communication.

Words Can Hurt

Kids are often told that the pain is “all in their head” (what does that mean, anyway?). They are told that they are making it up, that they just want attention, that they are too sensitive, that they need to just suck it up, and so on. The dismissal of the impact that the pain is having on the child and her family’s life is truly disheartening, impactful, and sometimes even traumatic.

One of my clients, who had chronic pain in middle school and high school, is now graduating from college. She has been pain-free for 4 years, yet she feels that her experience with the medical system (before she found Dr. Zeltzer, who saw her as a whole person and listened to her story) left her with psychological wounds that she is still working through.

She said that doctors made her “second-guess myself” and feel “small, ashamed.” Even though her physical pain is gone, the emotional damage has led her to question her beliefs and experiences, to doubt herself in relationships, and to feel unnecessarily shameful about herself.

What Can You Do As a Parent?

• Be aware of how a doctor’s words can affect your child. If something the doctor says makes you uncomfortable, chances are it didn’t go over your child’s head. Kids view doctors as powerful and knowledgeable (they get that message from society) – a doctor’s words may have a sustained impact on them.
• When doctors are asking questions, ask them to speak directly to your child instead of to you. This way your child will feel more important and, hopefully, heard.
• If you hear a doctor belittle or dismiss your child, let the doctor know that your child’s experience is not being validated. Tell the doctor that even if the pain cannot be seen, it is real. Let your child know that the doctor’s words do not mean that her pain is not real. Tell her you will continue to look for a practitioner who understands the situation.
• Before visiting a doctor, inquire as to whether the doctor views patients from a biopsychosocial model, where the whole child’s experience is considered. Ask if the doctor respects and refers to non-Western modalities as part of his or her practice, along with Western medicine.
• Make sure your child knows that you believe her feelings and her pain are real, even though what the doctor said felt shaming or dismissive. Make it clear to her that she is not doing anything wrong.
• Tell her that you are in this together and you will find a practitioner who understands.
• Check in with your child over the next days and weeks. Ask how she is feeling about what the doctor said and counter any feelings of shame that the doctor may have instilled. If your child seemed upset but cannot articulate her feelings, say the words for her and ask if you understand her feelings correctly. You might say, “I am guessing it felt pretty dismissive and hurtful when the doctor said your pain was ‘all in your head.’ I would have been upset about not being heard. Did you feel frustrated about not being understood?”
• Ask your child how the experience felt. Listen attentively and validate your child’s feelings. Make sure your child knows that you do not agree with the way the doctor spoke to her and that you will not give up on her.