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RESPECTING PAIN IN THE CHILDREN WE TREAT
The Lancet recently published report detailing how common it is for healthcare professionals to ignore, or otherwise take for granted, children’s pain.
Pediatric OT’s have known for a long time that hospital stays and medical procedures can lead to PTSD in children. But how often are we really respecting pain during therapy sessions?
Certainly we don’t want our patients to get hurt or to be in distress during therapy. But how often do we say things like “shake it off” or “you’re ok” or “you’re not really hurt” when a child falls or becomes upset about a task?
Obviously we aren’t trying to be mean. We’re often trying to redirect the child to something less distressing in order to avoid a meltdown.
However, there’s a fine line between trying to avoid a meltdown and inadvertently dismissing a child’s emotions. In an effort to avoid “babying” a child, we may be damaging our ability to establish a trusting relationship with that child because of a lack of empathy.
Is the child acting out because he doesn’t feel he’s getting enough attention? Why would that be? Does he need more reassurance? Is he really in physical pain? Does he have poor coping skills?
Asking these questions can lead to lots of new teachable moments in therapy. Respecting a child’s pain, no matter how insignificant it may look from where we are standing, may go along way toward helping the child develop confidence in your relationship and empathy with others.
Food for thought:
EVIDENCE FOR NON-CELIAC GLUTEN SENSITIVITY
It’s difficult to cut through the gluten-free diet fad sensationalism and find real science behind the idea of gluten sensitivity.
As someone who eats gluten with abandon and with no major consequences beyond rising numbers on my bathroom scale, it’s sometimes hard for me to understand the issues that other people have with gluten.
Alessio Fasano, MD is one of the country’s top celiac disease researchers, and I went down a rabbit hole of his research into gluten sensitivity looking for answers for a family who was considering a gluten-free diet.
This article stood out, but it’s behind a paywall. You can access the video for free. The article is from 2011, but it’s a great research update. The original research abstract is here.
Basically, there’s growing evidence for the existence of non-celiac gluten sensitivity in some people, and the disease process is distinct from that of celiac disease. They are two different issues.
Fasano’s research helps connect the dots between gluten sensitivity and lots of other diseases such as autism. While there’s no causal relationships, it is interesting to read about how one disease may effect another.
UNDERSTANDING NEUROCEPTION WILL CHANGE YOUR PRACTICE
Neuroception is a type of interoception that tells us whether we are safe or in danger. It encompasses the basic physiological processes that lead to fight/fright/flight behaviors or to more prosocial, engaging behaviors.
It’s the neurological system that tells you whether or not it’s ok to relax. This happens almost completely outside of our conscious awareness. Our emotions and emotional responses are triggered by our underlying neuroception.
When thinking about neuroception, “safety” means emotions or situations that are calming and that promote bonding and engagement. “Danger” means emotions or situations that are distressing and do not promote social engagement.
Many mental health issues are related to problems with neuroception. For example, anxiety and depression can be thought of as being defined by a neuroception of danger. Anxiety is a constant state of activation, verging on fight/fright/flight. Depression involves shutting down, or dissociation from circumstances in the face of stress.
Some children with reactive attachment disorder (RAD) have a faulty neuroceptive system and are unable to correctly appraise the safety and dangers of social relationships. Some children with RAD will seek bonds with anyone, indiscriminately, while other children with RAD are unable to bond with anybody.
A neuroception of safety is required for you to interact adaptively with other people in order to forge bonds and friendships. People with social anxiety have great difficulty maintaining friendships because their neurological systems are always flagging social situations as “dangerous”. They can’t relax enough to establish bonds with others.
Coregulation is a powerful influencer of neuroception. It’s possible to coregulate a person in a state of fight or flight into a state of calm by using a soothing voice, friendly facial expressions, open body language, and slow, rhythmic movements.
Similarly, it’s very easy to be coregulated into a neuroception of danger by watching the evening news.
It is impossible to coregulate anyone into a state of calm if your own neuroceptive system is in danger mode.
Many of our patients’ lives are dominated by a neuroception of danger. They are constantly on the verge of melting down or shutting down.
If you’re anything like me, many of your therapy sessions are devoted to coregulating children who can’t regulate themselves (i.e. letting them borrow your neuroception of safety).
I think the concept of neuroception is one of the most compelling ideas in the field of pediatric therapy right now. Neuroception organizes and helps explain a whole bunch of behaviors that we see on a daily basis. It also provides a way forward in helping kids manage some really hard emotions.
If you’d like to dive deeper, here are some great articles to get you started:
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