How Do I Know If My Baby Is in Pain?
Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist
Content reviewed against published AAP, NIH, WHO guidelines
Last reviewed:
If your baby has been diagnosed with or you suspect how do i know if my baby is in pain, here is what the evidence says.
The short answer
Babies cannot tell us when they hurt, but they communicate pain through behavioral and physiological signs. Key pain indicators include: a distinctive high-pitched, intense cry that differs from hunger or tired cries; facial grimacing (furrowed brow, squeezed-shut eyes, open mouth); body tension or rigidity; pulling away from touch; changes in feeding and sleeping; and increased heart rate. Healthcare providers use validated pain scales (like FLACC or NIPS) to assess infant pain. As a parent, you know your baby's baseline behavior best and can often sense when something is wrong.
Key takeaways
- Babies cannot tell us when they hurt, but they communicate pain through behavioral and physiological signs. Key pain indicators include: a distinctive high-pitched, intense cry that differs from hunger or tired cries; facial grimacing (furrowed brow, squeezed-shut eyes, open mouth); body tension or rigidity; pulling away from touch; changes in feeding and sleeping; and increased heart rate. Healthcare providers use validated pain scales (like FLACC or NIPS) to assess infant pain. As a parent, you know your baby's baseline behavior best and can often sense when something is wrong.
- Usually normal when: Your baby crying more than usual when teething
- Call your doctor if: Inconsolable crying that lasts more than 2-3 hours with no identifiable cause
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to AAP, NIH, WHO guidelines, babies cannot tell us when they hurt, but they communicate pain through behavioral and physiological signs. Key pain indicators include: a distinctive high-pitched, intense cry that differs from hunger or tired cries; facial grimacing (furrowed brow, squeezed-shut eyes, open mouth); body tension or rigidity; pulling away from touch; changes in feeding and sleeping; and increased heart rate. Healthcare providers use validated pain scales (like FLACC or NIPS) to assess infant pain. As a parent, you know your baby's baseline behavior best and can often sense when something is wrong. At 0-3 months, newborn pain signs include: high-pitched or intense crying, facial grimacing (brow furrow, eye squeeze, nasolabial furrow), limb withdrawal, trembling, changes in breathing pattern, and difficulty settling. The Neonatal Infant Pain Scale (NIPS) assesses facial expression, cry, breathing, arm and leg position, and arousal. Sucrose solution on a pacifier, skin-to-skin contact, and swaddling are evidence-based comfort measures for procedural pain in this age group. It is generally considered normal when your baby crying more than usual when teething. However, you should contact your pediatrician promptly if inconsolable crying that lasts more than 2-3 hours with no identifiable cause.
Normal vs. Concerning
When to Seek Immediate Care
- Inconsolable crying that lasts more than 2-3 hours with no identifiable cause
- Pain with abdominal distension, bloody stool, or vomiting (could indicate serious abdominal condition)
- Pain with fever, lethargy, or refusal to move a limb (could indicate infection or fracture)
By Age
What to expect by age
0-3 months
Newborn pain signs include: high-pitched or intense crying, facial grimacing (brow furrow, eye squeeze, nasolabial furrow), limb withdrawal, trembling, changes in breathing pattern, and difficulty settling. The Neonatal Infant Pain Scale (NIPS) assesses facial expression, cry, breathing, arm and leg position, and arousal. Sucrose solution on a pacifier, skin-to-skin contact, and swaddling are evidence-based comfort measures for procedural pain in this age group.
3-6 months
Pain signs become more recognizable as you know your baby better. A pain cry typically sounds different from hunger, boredom, or tiredness cries - it is often more urgent, higher-pitched, and harder to console. Your baby may guard or protect a painful area (pulling a leg up for abdominal pain, or refusing to use a limb for injury). Track when the pain behavior occurs to help your doctor diagnose the cause.
6-12 months
Babies at this age may show pain by reaching for or touching the painful area (pulling at ears for ear infection, rubbing their head). Changes in sleep patterns, appetite, or activity level can signal pain. Teething pain is common but usually mild - extreme distress warrants evaluation for other causes. Pain relief options include acetaminophen and ibuprofen (after 6 months).
12-24 months
Toddlers may begin to localize and point to pain. Watch for behavioral changes: a normally active child becoming quiet and clingy, refusing to walk (could indicate foot or leg pain), or avoiding certain movements. The FLACC scale (Face, Legs, Activity, Cry, Consolability) is widely used in this age group. Validate your child's pain - saying "I can see that hurts" provides emotional comfort.
2-3 years
Older toddlers may start using words for pain: "ow," "hurts," "boo-boo." They can sometimes point to where it hurts, though they may not always be accurate. Use picture-based pain scales (happy face to sad face) to help them communicate pain intensity. Never dismiss a child's expression of pain. Chronic or recurring pain warrants medical evaluation.
What to Tell Your Pediatrician
- Describe when you first noticed how do i know if my baby is in pain and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if your baby seems to be in pain but you cannot identify the cause.
- Mention if pain is interfering with your baby's feeding, sleeping, or daily activities.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
What Should You Do?
When to take action
- Your baby crying more than usual when teething
- Brief, intense crying during medical procedures (vaccines, blood draws) that resolves with comfort
- Mild fussiness after minor bumps during normal play
- Your baby being consolable within a reasonable time after the pain stimulus is removed
- Your baby seems to be in pain but you cannot identify the cause
- Pain is interfering with your baby's feeding, sleeping, or daily activities
- You want guidance on appropriate pain relief options for your baby's age
- Inconsolable crying that lasts more than 2-3 hours with no identifiable cause
- Pain with abdominal distension, bloody stool, or vomiting (could indicate serious abdominal condition)
- Pain with fever, lethargy, or refusal to move a limb (could indicate infection or fracture)
What You Can Do at Home
- Keep track of when you notice how do i know if my baby is in pain — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that your baby crying more than usual when teething — this is generally within the range of normal.
- At 0-3 months, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
- While monitoring at home, seek immediate care if inconsolable crying that lasts more than 2-3 hours with no identifiable cause.
Related Conditions
Could My Baby Be in Chronic Pain?
Chronic or recurrent pain in babies is pain that persists for weeks or occurs repeatedly. Unlike acute pain which has obvious causes (injury, illness), chronic pain may have less clear origins and can significantly affect your baby's development, sleep, feeding, and quality of life. Common sources include gastrointestinal conditions (reflux, milk protein intolerance), musculoskeletal issues, neurological conditions, or post-surgical pain. If your baby seems persistently uncomfortable, fussy, or has unexplained behavioral changes lasting more than a few weeks, discuss chronic pain with your pediatrician.
Tips for Giving Medicine to My Baby
Giving medicine to babies and toddlers can be challenging. Use the syringe or dropper provided with the medication for accurate dosing - never use a kitchen spoon. Aim the syringe toward the inside of the cheek (not the back of the throat, which can cause choking). Give small amounts at a time, allowing your baby to swallow between squirts. Medications can sometimes be mixed with a small amount of food or milk to improve taste, but check with your pharmacist first. Always use weight-based dosing, not age-based.
Caring for My Baby After Surgery
After surgery, your baby will spend time in a recovery area where nurses monitor their vital signs as anesthesia wears off. Most babies are groggy, fussy, and may refuse food for several hours. Pain management is a priority - your team will provide appropriate pain medication. Follow all discharge instructions carefully, including wound care, medication schedules, activity restrictions, and warning signs. Most babies recover remarkably fast, often returning to normal behavior within days of even significant procedures.
Related Resources
Frequently asked questions
Is how do i know if my baby is in pain normal?
When should I call the doctor about how do i know if my baby is in pain?
When is how do i know if my baby is in pain normal?
What causes how do i know if my baby is in pain?
What should I mention to my pediatrician about how do i know if my baby is in pain?
Is how do i know if my baby is in pain normal at 0-3 months?
Is how do i know if my baby is in pain normal at 3-6 months?
Should I go to the ER for how do i know if my baby is in pain?
Does how do i know if my baby is in pain go away on its own?
References
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss How Do I Know If My Baby Is in Pain?.
Things to mention
- Describe when you first noticed how do i know if my baby is in pain and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if your baby seems to be in pain but you cannot identify the cause.
- Mention if pain is interfering with your baby's feeding, sleeping, or daily activities.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- Your baby seems to be in pain but you cannot identify the cause
- Pain is interfering with your baby's feeding, sleeping, or daily activities
- You want guidance on appropriate pain relief options for your baby's age
Urgent signs to report immediately
- Inconsolable crying that lasts more than 2-3 hours with no identifiable cause
- Pain with abdominal distension, bloody stool, or vomiting (could indicate serious abdominal condition)
- Pain with fever, lethargy, or refusal to move a limb (could indicate infection or fracture)
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members
Related Resources
Bottom line
Most cases of how do i know if my baby is in pain are normal. Talk to your pediatrician if inconsolable crying that lasts more than 2-3 hours with no identifiable cause.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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Related Medical Concerns
Could My Baby Be in Chronic Pain?
Chronic or recurrent pain in babies is pain that persists for weeks or occurs repeatedly. Unlike acute pain which has obvious causes (injury, illness), chronic pain may have less clear origins and can significantly affect your baby's development, sleep, feeding, and quality of life. Common sources include gastrointestinal conditions (reflux, milk protein intolerance), musculoskeletal issues, neurological conditions, or post-surgical pain. If your baby seems persistently uncomfortable, fussy, or has unexplained behavioral changes lasting more than a few weeks, discuss chronic pain with your pediatrician.
Tips for Giving Medicine to My Baby
Giving medicine to babies and toddlers can be challenging. Use the syringe or dropper provided with the medication for accurate dosing - never use a kitchen spoon. Aim the syringe toward the inside of the cheek (not the back of the throat, which can cause choking). Give small amounts at a time, allowing your baby to swallow between squirts. Medications can sometimes be mixed with a small amount of food or milk to improve taste, but check with your pharmacist first. Always use weight-based dosing, not age-based.
Caring for My Baby After Surgery
After surgery, your baby will spend time in a recovery area where nurses monitor their vital signs as anesthesia wears off. Most babies are groggy, fussy, and may refuse food for several hours. Pain management is a priority - your team will provide appropriate pain medication. Follow all discharge instructions carefully, including wound care, medication schedules, activity restrictions, and warning signs. Most babies recover remarkably fast, often returning to normal behavior within days of even significant procedures.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.