Why Bilingual Children Process Pain Differently — A Stunning New Finding

When a bilingual child describes pain in two different languages for the first time, you notice something odd before you can identify it. The expression changes. The shoulders tighten or soften. The word “hurt” itself has a distinct weight. Parents are aware of it. Sometimes pediatricians do the same. However, for years, no one had been able to confirm what many caregivers had long suspected: that language could be used for purposes other than describing pain. It may influence how one experiences pain.

This suspicion has been made public by a recent University of Miami study. Researchers working with bilingual adults who speak Spanish and English discovered that when participants were speaking Spanish instead of English, they consistently rated the same pain stimuli as being more intense. The distinction was not insignificant. It was the kind of void that causes a clinician to hesitate. The implications extend directly into pediatric wards, school nurses’ offices, and the uncomfortable, fluorescent-lit moments before a vaccination, even though the participants in this study were adults.

This could be written off as a peculiarity of self-report. However, pain has never been solely physical. That is evident to anyone who has sat with a toddler prior to a blood draw. Something shapes the cry that emerges, such as culture, expectations, or the words a grandmother whispered years ago. The lead author of the study, Morgan Gianola, came up with the question after learning Spanish and then Portuguese and observing how each language seemed to convey emotion in a different way. Words seem to be more than just labels for emotions. They may adjust it.

When kids are involved, that tuning is more important. The results of a 2017 cross-sectional study comparing Chinese and Italian children during venipuncture procedures appeared contradictory at first. On self-report measures, the Chinese children reported more pain (mean score of 5.3 compared to 3.2 for the Italians), but they displayed less behavioral distress (mean score of 4.1 compared to 8.1). By their own admission, they were experiencing more pain but not expressing it as much. The language used to guide them through the situation, cultural norms regarding poise, and family expectations regarding self-control all influenced how the pain was expressed and carried out.

It becomes uncomfortable at this point. Undertreating Black and Hispanic patients‘ pain has a long and documented history in American healthcare, and pediatrics is no different. What is lost if a clinician switches a Spanish-speaking child to English for easier charting and the child reports more severe pain when speaking Spanish? Under the doctor’s pen, the entire pain assessment may change silently and unnoticed.

One Miami study can only make certain claims. The participants were adults, the sample size was small, and the methodology was still being improved. It will take years to replicate the results across age groups, dialects, and clinical settings. Even so, it’s difficult not to believe that the medical community has been measuring something more subtle than it realized. Pain scales are predicated on the idea that a “seven” is generally equivalent for all patients. What happens if it doesn’t? What would happen if a seven in Spanish had a different body than a seven in English?

It is admirable that the researchers are cautious not to exaggerate their findings. However, for the millions of parents in the US alone who are raising bilingual children, the discovery becomes somewhat intimate. Perhaps the bilingual child isn’t being dramatic or stoic when they shrug off a scraped knee in one language while wincing in another. Perhaps both responses are accurate. Perhaps pain picks up the language of its upbringing, just like everything else the mind comes into contact with.