Could pain, constipation or illness be behind my child's behaviour?

The short answer

A marked change in sleep, eating, movement, toileting, communication, tolerance, activity or behaviour can be a sign that a child is unwell or in pain, particularly when they cannot identify or describe a body sensation. Compare the child with their own baseline and check body systems: mouth and teeth, ears and throat, breathing, skin, stomach and bowel, urine, movement, sleep, medication, eating and drinking. Record when the change began, what comes before it, where the child touches or protects, temperature and other measurable symptoms, what temporarily helps and what school sees. Do not assume one distressed behaviour points to one diagnosis, and do not let a sensory or behavioural explanation close the physical-health enquiry. Arrange GP, dental or other appropriate assessment and ask what has been considered, what remains uncertain and what change should trigger earlier review. Use urgent services for breathing difficulty, collapse, severe or rapidly worsening pain, serious injury, marked drowsiness, dehydration, a stiff neck with illness, non-blanching rash or another acute danger.

• Compare with the child's own baseline rather than waiting for a conventional pain report.
• Check several body systems without trying to diagnose from behaviour alone.
• Record timing, observable signs, function and what temporarily changes the presentation.
• Keep physical health, mental health and environmental explanations open together.
• Ask the clinician to document the plan, uncertainty, follow-up and urgent threshold.