context: It can be a challenge to recognize the symptoms of pain in children. Is he really hurting, or am I overreacting? Does she really have headaches when the doctor can't find anything wrong? Pain is a highly individual and complex experience. What follows is the advice of experts for reading symptoms of pain in your child. Unlike with older children, crying isn't always a reliable pain indicator in babies. That's because crying is a baby's way of expressing a whole host of needs. Here are signs that a baby may be in pain. Changes in crying patterns. A baby's distressed cry sometimes, but not always, sounds different from ordinary crying. Changes in your baby's behavior can also be a tip-off. For example, crying that can't be soothed with a bottle, diaper change, or cuddling could signal pain. Also, a calm baby who becomes unusually fussy could be in pain. Crying while nursing. The baby who cries while nursing could very well have a painful ear infection. Prolonged, intense crying, often at the same time each day. This behavior is common with colic. It often starts at the age of 2 weeks, peaks at 6 weeks, and then gradually declines. Crying and drawing the legs up to the abdomen. Your baby could have colic or a serious medical condition. Withdrawing. Chronic pain can sap a baby's energy, causing him or her to become still, quiet, and to avoid eye contact. Fortunately, at this age, children in pain can talk, if only to say, " Owie, owie, owie!" They will often also clutch the part that hurts. Pulling or rubbing the ear is common in toddlers and although it can sometimes indicate ear pain, it may be habit. Suspect an ear infection if your child has had cold symptoms or a fever and begins to tug at the ear suddenly. Chronic or recurrent pain is common in children and adolescents. Research has shown that as many as 30% to 40% complain of pain at least once a week. Consult your child's healthcare provider to determine the cause and to get treatment. Acute abdominal pain. Pain that comes on suddenly can be caused by viral infections or by something more serious like appendicitis. If your child's pain seems to be localized to the right of the belly button and is accompanied by nausea, vomiting, and desire to stay very still, she should be evaluated for appendicitis. Recurrent stomachaches and headaches. A stomachache that goes away after a bowel movement could signal a problem with constipation or, less often, inflammatory bowel disease. Daily abdominal pain without nausea, vomiting, or diarrhea could be a special form of migraine, or could fall under the category of chronic recurrent abdominal pain, a common but frustrating complaint in children. Headaches are often associated with a viral illness. But those that occur frequently, often around the same time of day, or accompanying a girl's menstrual period, and cause your child to be nauseous or sensitive to light could be migraines. Recurrent body aches, usually along with trouble falling or staying asleep, could mean your child is depressed or anxious. Both conditions are often underdiagnosed in children and are known to trigger or increase pain. Chest pain. Chest pain that comes and goes, and can be reproduced by pressing on the chest, can be caused by muscle strain or inflammation of the rib cartilage and often occurs after your child takes up a new sport, increases physical activity, or experiences muscle tension due to emotional stress. Chest pain following an injury could indicate a broken rib or collapsed lung. Persistent chest pain is less common and could mean your child has asthma or an infection, such as pneumonia. Rarely is chest pain in otherwise healthy children caused by heart problems. However, if your child's chest pain is accompanied by dizziness, shortness of breath or fainting, especially with exercise, bring him to the doctor for evaluation. Know that even if doctors find no physical cause for pain in a child, something is still wrong. If pain occurs only on school days, look into what's happening in the classroom or on the playground. If having pain is the only time your child gets your attention, carve out special time with your child each day: Play. Take a walk. Read a book before bed. Finally, don't ignore chronic pain in your child. Your child may need the help of a multidisciplinary pain management team that might include a pediatric pain management specialist, psychologist, nurse, or nurse practitioner, and physical therapist. Talk to your child's pediatrician.