If your child has recurrent pains, please collect the
following information about the pain during three bouts of
pain before you make an initial or follow-up appointment.
This information may be very helpful in reaching a correct
diagnosis.
1. Date:
Time of day:
Place (home, school, etc.):
People present:
2. Describe the Pain
Where on the body?
How long did it last (in minutes)?
How bad (on a scale of 1 to 10 where 1 = mild, 10 =
unbearable)?
What did it keep your child from doing?
3. Triggers for Pain
Thoughts (any stresses) before the pain (within 1 hour)?
Feelings (upset or fearful) before the pain (within 1
hour)?
Activities before the pain (within 2 hours):
Food eaten before the pain (within 4 hours):
4. Treatment
What did you do to make it feel better?
5. Your Observation
What do you think was the cause of the pain this time?
Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
Copyright © 2006 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
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