Mass media exert an enormous influence on children’s development and is very likely how they learn about pain. Understanding the powerful influence that media has on preschoolers and kindergarteners is important because this is a crucial developmental period for socio-emotional development and is precisely the time when fears about pain (especially needles) develop.
Like it or not, pain is an inevitable part of childhood. In Canada, children receive 20 vaccine injections before the age of five. From the time that toddlers begin walking, everyday pains or “boo-boos” — minor injuries that result in bumps and bruises — are extremely common, occurring nearly every two hours.
By the time they reach adolescence, one in five youth will develop chronic pain. This means pain lasting for three months or more, like headaches and stomach aches. Chronic pain is a rising epidemic around the world, especially in girls. If these youth do not receive proper treatment, chronic pain during adolescence can lead to pain and mental health issues (PTSD, anxiety, depression, opioid misuse) into adulthood.
Simply put, pain is a big part of childhood. Yet, as a society we avoid, undertreat and stigmatize pain. Despite decades of research showing how to effectively manage children’s pain (for example, using numbing creams or distraction techniques), studies show that many clinicians still undertreat children’s pain, and neither acute (short-lasting) nor chronic (lasting three months or more) pain is well-managed.
Children who experience chronic pain are also stigmatized and often disbelieved by peers, health-care professionals and teachers. These deeply ingrained societal beliefs about pain likely influence how children learn to experience, respond and empathize with pain.
So where does this social stigma of pain come from? What do Disney, Pixar and Netflix have to do with your child’s pain?
Children’s media exposure
Children are growing up saturated with mass media and rates of screen time are rising. The COVID-19 pandemic has only fuelled this further. While the American Academy of Pediatrics recommends that preschool-aged children watch no more than one hour of TV per day, the majority of children far exceed this recommendation.
In our study, we used popular culture lists to capture the most popular movies and TV shows seen by millions of four-to-six-year-old children. The final list included Despicable Me 2, The Secret Life of Pets, Toy Story 3 and 4, Incredibles 2, Inside Out, Up, Zootopia, Frozen, Finding Dory, Sofia the First, Shimmer and Shine, Paw Patrol, Octonauts, Peppa Pig and Daniel Tiger’s Neighbourhood.
We watched all 52.38 hours of media and all instances of pain were captured. We used established coding schemes drawn from the procedural and everyday pain literature to code details of the pain experience, including both the sufferers’ and the observers’ responses, the type of pains depicted and the degree to which observers showed empathy to the characters in pain. We examined gender differences in the pain experiences of boy versus girl characters.
The results were shocking. Pain was frequently depicted, approximately nine times per hour. Seventy-nine per cent of pain instances involved characters being seriously injured or experiencing pain due to violent acts. Although everyday pains are the most common pain experiences young children experience in real life, everyday pains comprised only 20 per cent of the pain instances. Medical and procedural pain, like needles, as well as chronic pains were depicted less than one per cent of the time.
When characters experienced pain, they rarely (only 10 per cent of the time) asked for help or showed a reaction, perpetuating an unrealistic and distorted perception of pain that shows pain as being quickly swept aside. Although 75 per cent of pain instances were witnessed by observers, they rarely responded to characters experiencing pain, and when they did, they showed very low levels of empathy or concern toward the sufferer.
Across the media, boy characters experienced the vast majority of pain, despite girls experiencing higher rates of pain problems in real life. This underrepresentation of pain in girl characters could be teaching young children that girls’ pain is less frequent, real and worthy of attention from others. Indeed, we found that girl characters were less likely to seek help when they experienced pain than boy characters.
Boy characters experienced more severe and distressing pain than girls; however, observers were more concerned about, and likely to help, girl characters. Observers were more likely to show inappropriate responses (laughter) to boy sufferers. Boy observers were more likely to laugh and offer verbal advice to sufferers, whereas girl observers were more empathetic toward sufferers.
Frequent and unrealistic portrayals of pain
These findings reveal that popular media are perpetuating unhelpful gender stereotypes about pain, with girls being depicted as damsels in distress who show more caring and empathy and require more help, and boys being portrayed as stoic and uncaring towards others.
At critical developmental periods when young children are learning about themselves, others and the world, they are seeing pain frequently portrayed in their favourite TV shows and movies. In children’s media, pain is frequently depicted (nine times per hour), it is unrealistically and often violently portrayed, empathy and helping is rarely depicted, and unhelpful gender stereotypes abound.
These messages are potentially harmful as we know that children turn to their favourite characters to understand and make sense of their everyday experiences such as pain and importantly, to learn how to respond to their own pain and pain in others.
These findings highlight a pervasive societal stigma around pain that is being communicated to young children. This highlights the responsibility that we all have in dismantling and changing these societal narratives about pain to ensure that this powerful social learning opportunity is not missed and we are raising more prepared and empathic children for the inevitable pains they will encounter throughout their lives.
This story is part of a series produced by SKIP (Solutions for Kids in Pain), a national knowledge mobilization network whose mission is to improve children’s pain management by mobilizing evidence-based solutions through co-ordination and collaboration.