How do you deal with overreactors?

[BrisketRN, BSN, RN]

If a child is injured and there's no objective sign of a break, but they're rating their pain very high, crying, upset, saying they can't move injured area etc. do you call their bluff or call parents? I tend to ice for 20 minutes and if the high pain rating, wincing, crying continues I'll call home and suggest bringing to see a doctor. I figure if it's just overreacting then parents can deal with it at home.

At the same time, if I call a parent and they say their child tends to overreact I'm happy to keep them in school & reassess later or let the parent talk to the child.

What do you do?

[OldDude]

I play along at first, give them time to see if they get tired if the acting, and if they persist after a half hour or so, and the complaint remains consistent, I'll go ahead and call a parent.

[ruby_jane, BSN, RN]

Usually ice/rest/elevation and therapeutic silence will tell those in real pain from those who are overreacting. Someone with 10/10 pain who voluntarily gets up, stating relief felt in 6 minutes is fine.

And if all else fails...I lay it back on the parent because - what if I'm wrong? I have been wrong before. Usually I am right, it's minor, but I have a lot of parents tell me they appreciate me for calling and I think it's a win-win.

[jnemartin, BSN, RN]

23 minutes ago, ruby_jane said:

Usually ice/rest/elevation and therapeutic silence will tell those in real pain from those who are overreacting. Someone with 10/10 pain who voluntarily gets up, stating relief felt in 6 minutes is fine.

And if all else fails...I lay it back on the parent because - what if I'm wrong? I have been wrong before. Usually I am right, it's minor, but I have a lot of parents tell me they appreciate me for calling and I think it's a win-win.

Therapeutic silence: I love that term!

Also, I know pain is subjective, but when a 12 year old tells me their arm is in 10/10 pain after being hit by a football during PE I want to lose my mind ?

[kidzcare]

Therapeutic boredom.

I have one that stands out in my mind that I was on the fence if the kid was overreacting. He came in from PE, seemed mostly OK until I asked him to lift his arms. That was when he was having pain. It persisted so I called dad to pick him up (told him it was an arm/shoulder injury, this is important later in the story) and had the kid go back to the locker room to change. He comes back in his PE shirt and normal pants. Couldn't lift his arm to change the shirt, no complaints of pain until it was time to lift the arm, sitting calmly in my office.

Dad arrives to pick him up... on his motorcycle. I told him the kid couldn't raise his arms and he huffed off saying "Now I have to go home and get the car!" Ok, you do that. Assessed the kids arm raising again. Now it had been about an hour with ice and still can't lift. Dad takes him in to the doctor and he had a broken clavicle.

[kidzcare]

2 minutes ago, jnemartin said:

10/10 pain

To the older kids, I'll ask "10/10? Really? So you could only be in more pain right now if you were being drawn and quartered?"

Bonus: explaining what drawn and quartered means to a gape mouthed 13 year old

[jnemartin, BSN, RN]

1 minute ago, kidzcare said:

To the older kids, I'll ask "10/10? Really? So you could only be in more pain right now if you were being drawn and quartered?"

Bonus: explaining what drawn and quartered means to a gape mouthed 13 year old

Sometimes I press them a bit and say "10/10 as in this is the worst pain you have ever felt in your life" (to which they say yes lol), or I just turn my head and roll my eyes into the back of my head.

[OldDude]

Elementary level...I don't do pain scales.

[EnoughWithTheIce]

I use the therapeutic silence trick a lot. I am in middle school so the last thing I want to do is to play into the drama.

If they persist with their complaint after all interventions then there really is no choice but to put the ball in the parent's court. If the parent runs up and it turns out to be nothing, oh well.......I am covered.

If they choose to do nothing and it turns out to be something, I am covered again.

[BrisketRN, BSN, RN]

10 minutes ago, OldDude said:

Elementary level...I don't do pain scales.

I just do the FACES pain scale, which can be useless at times because they'll pick 10/10 if they're crying.

[jnemartin, BSN, RN]

10 minutes ago, OldDude said:

Elementary level...I don't do pain scales.

What's interesting is that I actually use this pain scale in my assessment (because they cannot answer properly as I've described) ~ they offer it up! Maybe they've heard it from their parents or on TV?

I think I've asked for a numeric pain scale maybe twice when I've suspected a fracture, but find it more helpful to ask something like "Have you ever had pain like this before? What does it feel like? Can you move it?" etc.