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.
Time of day:
Place (home, school, etc.):
People present:
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?
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):
What did you do to make it feel better?
What do you think was the cause of the pain this time?
