A rare condition known as congenital analgesia—also called congenital insensitivity to pain (CIP)—prevents a child from feeling pain, putting safety at risk. Learn the dangers and helpful adaptive behaviors.
Birth Right
When Julia’s doctor confirms her pregnancy, she’s ecstatic. Ever since babysitting as a teen, she wanted a child of her own. Now, the beauty of conception has begun.
It’s too early now, but she believes she can already feel the kicks—likely her fluttering heart. There’s so much to plan and do, including doctors’ visits, healthy eating, and regular exercise.
Her husband, Ethan, is already sending photos of cribs during break time at work. She stands in a small room called an office and imagines a nursery.
Julia does everything right through each trimester. Her husband childproofs the home before Nester is a toddler. During a vaccination visit, Julia winces at the prick while Nester remains silent.
“How did you pull that off?” she asks.
“A little numbing agent on the injection site and my distracting lullaby seemed to work.”
Julia rocks him in her arms. “I just like to think that he’s a strong boy.”
First Steps
There were many false starts, where Nester held onto outstretched fingers while bouncing his knees before crying to be held or sitting down. Mom kept urging Ethan to start recording.
On a day Ethan isn’t home, Nester takes his first steps while she’s sitting on the floor, legs straight. Julia reaches for her phone and turns around a second later to see Nester on the floor. She rushes over to soothe him, but he’s not crying.
She begins thinking—he didn’t cry during the vaccinations, or the fever he had. Now, he may have hit his head, and he’s silent.
Her boasts of being a strong boy have her concerned that something’s developmentally wrong. She phones Ethan.
“Hey, babe. Our young man took his first steps today.”
“Sorry, I missed it. Did you record it?”
“It happened so quickly, I couldn’t. Quick question, though: Do you ever recall Nester crying from a bump or bruise?”
“Not offhand. I childproofed the house, and I’m happy to have a quiet night’s sleep.”
“Something’s off. I’m going to schedule a visit with his pediatrician.”
No Pain
Julia bounces little Nester in her arms while speaking to the doctor.
“My boy… he doesn’t cry. Believe me, I don’t want him to, but except for a little noise when he’s hungry, I can’t recall him ever responding to pain.”
“Allow me to squeeze his hand.”
Nester gently tugs back while looking around the room. The doctor pinches, and the baby smiles.
“Lie him down on the exam table and hold his hands,” the doctor says.
He removes the shoes and drags a blunt instrument on the soles of his feet without a reaction. Then, with the baby’s hand flat on the exam table, the doctor presses the flat of the ballpoint pen on the fingernails.
“Interesting,” the doctor says. “No sign of paralysis, but he doesn’t respond as he should to stimuli.”
The doctor shines a light in Nester’s mouth while Julie straps his little shoes back on.
“No bite marks on his lips or tongue. That’s good.”
“You keep saying something’s good, but you seem concerned. What is it?”
“When he’s a bit older, we can confirm the diagnosis through neurological exams, skin biopsies, and genetic testing. Empirically, I suspect a very rare condition called Congenital Insensitivity to Pain (CIP). It’s also called Congenital Analgesia.” [1]
Julie furrows her brows while rocking Nester.
“So, what do I do?”
“A person who can’t feel pain can’t avoid it. When you walk near a hot oven, you grab a mitten. When it’s freezing, you bundle up. If a bush has thorns, you recoil when pricked. A person with CIP lacks the pain receptors that normally serve as a protection.”
“Do you mean he could break a leg and not feel it?”
“Theoretically, yes. Burns, tongue bits, and sometimes the absence of sweating are things to monitor.”
“So, I’m supposed to wait until he bites his tongue off or breaks a bone?”
“If you suspect an injury, by all means bring him in—take him to urgent care for a timely evaluation.”
She tightens her grip instinctively, realizing how much she had relied on pain to tell her when something was wrong. “Now, I’m afraid to let him out of my sight.”
“A close eye is not a bad idea, but you can take reasonable precautions like bundling him up well in the cold, making certain that he doesn’t walk barefoot, and using padding for his head and hands. There are also little elbow and knee pads available.”
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“My poor baby will look like a snowman. Why did you mention sweating?”
“We perspire to cool our bodies when air blows against the dampness. It’s called thermoregulation. Anhidrosis, the lack of sweating, can lead to fevers. Conversely, the inability to feel cold can result in hypothermia.” [2]
“Now, you have me more frightened.”
“That’s normal. But there’s no damage yet. If it does occur, you know the reason and can respond without blaming yourself.”
“Are there any more signs I should look out for?”
“When he’s teething, keep mittens on his hands. I have seen cases where a child chews the tips of their fingers off. Just get him a teething ring.”
“Will my baby never cry?”
“Unless he has conjunctivitis, he’ll cry for different reasons—to get attention, or when older, an emotional response—but not as a reaction to pain.”
“Wow. My husband was thinking Nester was a candidate for football.”
“I wouldn’t recommend contact sports.”
“Well, I’ll just need to stare at his handsome face more often.”
“That’s the right attitude. I’ll print out the instructions so you can go over them with your husband. Bring Nester in every three months for a wellness exam, or, as I mentioned, go to urgent care if necessary.”
FAQ: Caring for a child diagnosed with congenital analgesia
What is congenital analgesia in children?
Congenital analgesia is a rare condition in which a child is born unable to feel physical pain despite otherwise normal touch and temperature sensation. Because pain serves as a warning system, this absence poses serious safety risks.
Why is not feeling pain dangerous instead of helpful?
Without pain, injuries may go unnoticed. Children with congenital analgesia might continue walking on broken bones, bite their tongues, burn their skin, or develop infections without realizing anything is wrong. Caregivers must be vigilant for signs of injury.
How do families manage daily life with a child who cannot feel pain?
Management often includes frequent medical checkups, home safety modifications, teaching visual checks instead of relying on pain, and working closely with specialists such as neurologists, pediatricians, and orthopedic teams. Emotional support for the family is also essential.
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