Clinical Considerations from a Social Systems Perspective

At home, the push and pull of family dynamics, like how attuned caregivers are to a child’s emotions, whether parents lean toward overprotection or withdrawal, and even a family history of pain, can lead harmless sensations to be interpreted as threatening. Early experiences of secure attachment teach children that their feelings matter and can be soothed, while attachment disruptions leave threat circuits on high alert, making pain and dizziness more likely to take root (Garland, 2012).

School life adds another layer. Kids with persistent pain often miss classes, struggle to keep up, and report fewer friendships and greater peer victimization than their classmates—social ripples that reinforce isolation and heighten symptom vigilance. A teacher who collaborates on flexible attendance or assignments can play a supportive role in creating more of a felt sense of safety.

Beyond family and school, community and culture shape how pain and dizziness are understood and addressed. Neighborhood resources e.g., community centers, youth sports, and accessible healthcare, offer opportunities to address fear and avoidance, as well as connect. Cultural beliefs about toughness or stoicism can either stigmatize symptom sharing or empower honest communication, and socioeconomic barriers often limit access to specialist care, play therapy, or even safe play spaces.

By weaving a child’s home life, school experience, friendships, attachment history, and cultural context into each treatment plan, clinicians can help reframe pain and dizziness not as foes but as learned alarms that can be unlearned.

Check out more information in our workbook on how to incorporate these social factors into treatment with children with chronic pain.

Garland EL. Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways. Prim Care. 2012 Sep;39(3):561-71. doi: 10.1016/j.pop.2012.06.013. Epub 2012 Jul 24. PMID: 22958566; PMCID: PMC3438523.