When children are in pain, their parents usually know it. However, pain can be difficult for a child to describe. An older child may be able to describe the pain as sharp or cramping or tell whether the pain comes and goes (intermittent). When a young child is in pain, the signs are sometimes hard to recognize. Watch for changes in how your child acts.

The signs listed below may help you decide whether your child's pain is mild, moderate, or severe. A child with severe pain will have more of these behaviors, the behaviors will be more constant, and you will be less able to comfort the child. Look for:

• Changes in usual behavior. Your child may eat less or become fussy or restless.
• Crying, grunting, or breath-holding.
• Crying that can't be comforted.
• Facial expressions, such as a furrowed brow, a wrinkled forehead, closed eyes, or an angry appearance.
• Sleep changes, such as waking often or sleeping more or less than usual. Even children in severe pain may take short naps because they are so tired.
• Body movements, such as making fists, guarding a part of the body (especially while walking), kicking, clinging to whoever holds him or her, or not moving.

A child between the ages of 18 months and 3 years may complain of pain or tell you that he or she is not feeling well.

Passing hard stools irritates and may tear the tissues lining the rectum and anus, causing pain and bleeding. Pain caused by passing a hard, dry stool will usually go away shortly after the bowel movement.

If a child continues to have severe rectal pain for longer than 30 minutes after a bowel movement, a visit to a health professional is usually needed.

Rectal pain caused by constipation can trigger a vicious cycle: Pain discourages a child from trying to have a bowel movement, which worsens the constipation, which causes more pain.