“My Child Only Tells Me They’re in Pain at Bedtime.” Why Does This Happen?

A question I hear often from parents and carers goes something like this:

“Every night, just as it’s time for bed, my child tells me something hurts. Is this just behaviour? Are they trying to avoid going to bed? Or is the pain real?”

It’s such a difficult question because, on the surface, it can look like a pattern. Every bedtime. Every night. Just as the lights are about to go out. After a while, it’s understandable that families begin to wonder whether the timing means something else is going on.

But what if bedtime isn’t when the pain starts?

What if it’s simply the first moment your young person is able to notice it?

Image from Canva by ranyanya from Picturenya

You may also be interested in some of my other sleep blogs ‘Protecting Relationships When Sleep is Hard for PDAers’, ‘Why Waking Up in the Morning Is Hard (It’s Hormones, Not Behaviour)’ and ‘Webinar Recording and Write Up: What can we do about sleep difficulties when home doesn’t feel safe?’

A day full of competing signals

For many neurodivergent children and young people, the daytime is incredibly busy from a nervous system perspective.

They’re navigating conversations, classrooms, sensory input, transitions, expectations, social interactions, body movements, decision-making, masking, energy and emotional regulation. Their brains are filtering, prioritising and reacting to an enormous amount of information.

When so much is happening, the nervous system may give more attention to the many demands of the environment than to pain signals coming from the body.

This doesn’t necessarily mean the pain isn’t there. It may simply not be the most urgent piece of information for the brain to process at that moment.

When the world becomes quieter & less demanding

As bedtime approaches, many of those competing demands begin to fall away.

The lights are dimmer. Conversations slow. There are fewer decisions to make. The sensory environment often becomes calmer.

With fewer incoming demands, the brain has more capacity to notice internal sensations.

• That background headache.
• The aching ankles after a busy day.
• The stomach discomfort that was easy to ignore during school lessons.
• The growing awareness that their jaw hurts, their muscles ache, or their skin feels uncomfortable.

Rather than pain appearing out of nowhere, it may be that the nervous system is finally able to tune into signals that have been present all along.

“But why didn’t they mention it earlier?”

This is another question I hear frequently.

The answer is often more complex than simply not wanting to or not bothering to.

Recognising pain requires interoception (the ability to notice and interpret what is happening inside our bodies). For many neurodivergent people, these internal signals can be difficult to identify, understand or put into words.

Sometimes there isn’t enough awareness to recognise the sensation until the environment becomes quieter.

Sometimes the sensation has been building gradually throughout the day and only crosses the threshold where it becomes impossible to ignore once they stop moving. And sometimes they genuinely don’t realise they are in pain until they slow down or lie still.

Growing pains, headaches, constipation, reflux, hypermobility-related discomfort, fatigue, muscle soreness after physical activity, menstrual pain, migraine, illness, or other medical conditions can all become more noticeable in the evening.

Looking for patterns & staying curious

If bedtime pain is becoming a regular occurrence, keeping a simple record for a couple of weeks might be helpful.

In addition to writing down what hurt, notice what happened during the day beforehand too.

• Was it a PE day?
• Were there lots of transitions?
• Was school particularly demanding?
• Had they eaten less than usual?
• Have they drunk enough?
• Was sleep already disrupted?
• Were they overwhelmed or emotionally exhausted?

You may end up seeing some patterns across the week. 

A final thought

The timing of pain doesn’t always tell us when it began. Sometimes it tells us when the nervous system finally had enough space to notice it.

For many neurodivergent children and young people, bedtime may simply be the first quiet moment in a day and when they can begin communicating needing support. 

Thank you for being here,

Laura Hellfeld

RN, MSN, PHN, CNL

Connect with me on social media

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Signposting and Resources

• Flush Forward!: A Friendly Toileting Guide for Parents Supporting Disabled and Neurodivergent Young People
• Belonging First: Building Connection & Trust in the Primary Classroom
• Creating Safe Spaces for Autistic People
• Gabby’s Glimmers: An Affirming Story of an Autistic Child and their Favourite Food
• Protecting Relationships When Sleep is Hard for PDAers, Blog
• Why Waking Up in the Morning Is Hard (It’s Hormones, Not Behaviour)’, Blog
• Webinar Recording and Write Up: What can we do about sleep difficulties when home doesn’t feel safe?

Disclaimer: The information shared in this blog is for informational purposes only and is not intended to replace medical advice, diagnosis, or treatment. Please consult a licensed healthcare provider for personalised support and care tailored to your specific needs.