Aboriginal children express pain differently: IWK research

WATCH: Researchers at the IWK are looking into the different ways Aboriginal children describe and express pain. They hope their findings help healthcare professionals better treat and assess Aboriginal patients. Julia Wong explains.

HALIFAX – New research out of the IWK Health Centre aims to help Aboriginal children better express their pain and assist healthcare workers in better assessing and treating them.

Dr. Margot Latimer, an associate professor at the Faculty of Healthcare Professionals at Dalhousie University and faculty member of the IWK’s Centre for Pediatric Pain Research, is the co-lead of the Aboriginal Children’s Hurt and Healing Initiative (ACHH). The project is believed to be the first of its kind in the country.

Latimer  and her team completed a project on the Eskasoni reserve interviewing children from Grade one to 12, their parents, health professionals and elders.

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“We learned a consistent theme,” she said. “Children are stoic with their pain and they hold it in. There seemed to be some relationships with the residential school experiences of their grandparents.”

“They wouldn’t express themselves. They wouldn’t show it on their face. They wouldn’t cry so it’s desirable to be brave and tough out your pain.”

But she said that impacted how the Aboriginal community interacted with the healthcare system.

“We learned they feel frustrated at times. When they do seek treatment for their pain and hurt conditions, that they don’t feel satisfied with that. They don’t feel they’ve been able to convey their level of pain.”

“We heard if they were hurt, there was a process of keeping it in, maybe keeping it to themselves and trying to deal with it themselves. It wasn’t condoned to talk about their hurt or their pain.”

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The findings are something Alan Syliboy is familiar with.

The Mikmaq artist recalls going to the IWK as a child and finding the environment very intimidating.

“For a Native child that has never been away from the community, it’s a very foreign environment. It was very difficult,” he said.

“You sort of retreat and you’re not open.”

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Syliboy grew up to become an artist and now uses his paintings to express his feelings and emotions, such as pain.

He is partnering with ACHH to reach out to Aboriginal youth and asking them to paint their pain. He describes his involvement with ACHH as a way to help bridge the gap between the Aboriginal and medical communities.

“I can help Native children express themselves easier,” he said.”And on the other side, the medical profession can also be plugged in and be able to benefit as well.”

Latimer said she heard many stories of frustrated parents taking their children, who were in pain but were stoic, to the emergency department.

“We teach health professionals to assessed pain based on [children’s] facial expressions, their cry, their ability to describe their pain. But if you grow up in a household where pain isn’t discussed, where it’s desirable that you suppress your pain, that’s the way you’re going to be.”

“So from a health professional perspective, if you’re looking in a room and you want to know who’s in the most pain and if a child is not expressing it, then that’s not a trigger for you to do anything about it. You’re going to take the child who’s crying first.”

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Latimer said Aboriginal community members felt they were being discriminated against in the healthcare system. She hopes her research helps better train doctors and nurses in triaging and assessing Aboriginal patients.

Dr. Allen Finley, the director of the Centre for Pediatric Pain Research, said pain in children, ranging from acute pain from sickness to pain from needles and surgery, is already under-recognized and can often lead to short-term and long-term consequences.

He adds Aboriginal communities are under-served and overlooked by the healthcare system, which can further complicate the situation.

“We know that if you don’t treat acute pain well, you probably set up barriers to getting healthcare in the future. People are reluctant to come back to health professionals and hospitals if they have been hurt before,” Finley said.

Kara Paul, a co-collaborator on the project and the head of the Aboriginal Health Sciences Initiative at Dalhousie University, said the discrepancy between how Aboriginal patients express pain and how the general public expresses pain needs to be addressed.

“If their pain is not being picked up on or recognized, they’re not being fully assessed properly. That affects their lives,” she said.

“Pain can be very debilitating. From our research, we found half of our students miss school due to pain. What happens is, when you focus on pain, it’s very difficult to learn other things.”

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She said better education about Aboriginal children’s pain experiences will help them in the long-term.

“If we can recognize their pain early on and they’re not living with chronic pain, that can only enhance their school experience and their life experience all around.”

Latimer said she is now expanding her research to include Aboriginal communities in New Brunswick and Prince Edward Island.

She hopes to one day expand it across the country to look for patterns and trends.

A website for ACHH will launch later this week.

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