Pain Diary
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?
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Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
Published by RelayHealth.
Last modified: 1996-01-16
Last reviewed: 2010-06-02
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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 health care professional.
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