More than half of children living with chronic pain have struggled to get their symptoms taken seriously. And it can start much earlier in childhood than many pharmacists might expect.
Chronic Pain Australia’s Kids in Pain Report 2026 revealed more than half of children with chronic pain had experienced it by age 10, while approximately one in four had started experiencing pain by age 5.
But for many families, having their child’s pain taken seriously can take years. The report found 62% of respondents diagnosed with chronic pain had experienced dismissal or invalidation, while 39% waited 3 years or more for a diagnosis.
Families were most commonly told their child’s pain was anxiety (69%), normal (58%) or growing pains (57%).
For parents, that dismissal can delay diagnosis and access to timely, coordinated and appropriate care.
‘Pharmacists are in a good position to help with that navigation and that validation for parents and children if they’re not getting answers,’ said Nicolette Ellis MPS, Chair of Chronic Pain Australia.
The key, she said, is knowing what to ask, what to listen for and when to encourage the family to seek further assessment.
What should pharmacists ask to find out if pain is persistent?
One of the first things pharmacists should establish is how long the child has been experiencing pain.
‘If it’s more than 3–6 months, it’s a good indication that it’s a chronic condition and needs a thorough assessment,’ Ms Ellis said.
That does not mean pharmacists need to diagnose chronic pain. But persistent pain should prompt a closer look, particularly if a family has repeatedly been told it is simply growing pains or anxiety.
‘It depends on the age of the child, but [try] asking the parent first, “Who should I be asking? How do you want me to direct the questions?”’ she said.
‘Parents are usually a really good guide of how they communicate their pain.’
The next questions should be about how the child is functioning:
- Are they missing school?
- Sleeping poorly?
- Avoiding sport or seeing friends less?
- What can they still do and what has become harder?
It’s also useful to establish what the family has been told so far, whether the child has received a diagnosis and what is currently helping.
The first priority is validation, Ms Ellis said. Pain is real even when investigations have not identified an obvious cause.
How can pharmacists explain why the pain is still there?
One of the biggest challenges for families is understanding how a child can still be in pain when an injury has healed or no physical abnormality has been found.
‘What we naturally think is that if you have pain, there’s a problem that needs to be fixed, either by surgery or with some type of intervention. But, unfortunately, that’s not generally what happens,’ said Ms Ellis.
With chronic pain, the nervous system can become more sensitive and continue sending pain signals after the original tissue damage has healed as far as it can, she explained.
Persistent pain can have different underlying mechanisms, including ongoing or recurrent tissue injury (nociceptive pain), damage or disease affecting the nerves (neuropathic pain), and changes in how the nervous system processes pain (nociplastic pain). These mechanisms can also overlap, so understanding a child’s pain involves recognising that the pain is real while considering the different factors that may be contributing to it.
‘There’s not necessarily a surgery or an intervention that can stop that maladaptation of the nervous system.’
Rather than trying to reassure a parent that nothing is wrong, pharmacists can validate the pain while explaining that persistent pain does not necessarily mean there is ongoing tissue damage that needs to be fixed.
For younger children, Chronic Pain Australia’s Pharmacist’s Guide to Supporting Kids in Pain suggests explaining the nervous system as a guard dog that has become overprotective. For example: ‘When you first get hurt, the guard dog barks to protect you. But sometimes the dog keeps barking even when you’re safe. We can teach the guard dog to settle down.’
For teenagers, a better analogy might be: ‘Pain can come from muscles, joints, nerves, and the way the nervous system processes signals. Sometimes your body’s security system stays on high alert even after healing. The pain is real – it just means the system is protecting you too much.’
Could neurodivergence change how a child experiences pain?
The Kids in Pain Report 2026 found that 56% of children and young people with chronic pain were neurodivergent.
‘Some conditions that co-occur more frequently with ADHD and autism, such as joint hypermobility, could be contributing to chronic pain,’ Ms Ellis said.
‘Anxiety can also be a factor for some children and young people. Where anxiety is present, it could be contributing to their pain experience, but it’s important not to assume this is the case for every child with ADHD or autism.’
Some conditions that can co-occur with neurodivergence may also contribute to a child’s pain experience. Ms Ellis pointed to dysautonomia as an example, which the 2026 report identified in 15% of children with chronic pain.
Neurodivergent children may also experience or communicate pain differently. For example, a child may find it difficult to identify or verbalise what they are feeling, or their distress may be expressed through changes in behaviour. These changes should prompt consideration of possible pain or other unmet needs, rather than being automatically interpreted as behavioural problems.
Best practice for pharmacists is not to assume neurodivergence explains the pain, but to consider how a child’s individual sensory, communication and support needs may influence their pain experience and how they express it, she said.
How can pharmacists help families find a way forward?
If pain has persisted, pharmacists can encourage parents to return to their GP for further assessment. Parents may benefit from being given specific language to use, particularly if they have previously felt dismissed.
They can explain that:
- their child has been experiencing pain for more than 3–6 months
- they are concerned it may be chronic pain
- there is not yet a diagnosis.
The GP can then assess the child and determine whether referral to a paediatrician or pain specialist is appropriate.
Ms Ellis also encourages pharmacists to develop local knowledge of paediatric occupational therapists and physiotherapists who have experience in pain, particularly in rural and regional areas where there may not be a GP with a paediatric interest.
‘Trying to get them engaged with a good allied health professional can really change their trajectory,’ she said.
For families, it can be helpful to reframe what improvement looks like. Rather than expecting the pain to disappear completely, the focus may be reducing its impact on everyday life.
‘It’s all about how we improve their function and keep them doing the things that they love – giving them the skills to remain at school, to be active in their childhood and active in play.’
