# Timeline of diagnosed pain causes in children with severe neurological impairment

## TL;DR

This study explores how the causes of diagnosed pain in children with severe neurological impairment vary with age, aiming to improve diagnostic approaches.

## Contribution

The study identifies age-related patterns in pain causes for children with severe neurological impairment.

## Key findings

- Gastroenterological pain is most common in early childhood.
- Orthopaedic and tooth pain are more frequent in older children and adolescents.
- Surgical procedures like PEG placement and heart surgery are more typical in younger age groups.

## Abstract

Pain's causes in children with severe cognitive impairment may be challenging to diagnose. This study aimed to investigate if there is a relationship between pain causes and the age of children.

We conducted a multicenter retrospective study in three Italian Pediatric Units. Eligible subjects were patients from 1 to 18 years with severe neurological impairment. We collected data regarding diagnoses, pain causes and medical or surgical procedures. The timing of pain episodes was categorized into age-related periods: infants and toddlers (0–24 months), preschool children (3–5 years), schoolchildren (6–12 years), and adolescents (13–17 years).

Eighty children with severe neurological impairment were enrolled. The mean age was 11 years (±5.8). Gastroenterological pain was most common in the first years of life (p = 0.004), while orthopaedic and tooth pain was the most typical in schoolchildren and adolescents (p = 0.001 and p = 0.02). Concerning surgical procedures, PEG placement and gastric fundoplication were significantly more common in the first 5 years of age (p = 0.03), and heart surgery was typical of infants (p = 0.04). Orthopaedic surgery was more commonly reported in older children and adolescents (p < 0.001).

Some causes of pain are more frequent in children with severe neurological impairment in defined age-related periods. Specific age-related pain frequencies may help physicians in the diagnostic approach.