Learning About Pain and Illness: Physical Symptoms in German Children's Picture Books

Although picture books are among the most common early-childhood media for communicating information about pain and illness, little is known about how physical symptoms and responses to them are portrayed in contemporary picture books. This study examined physical symptoms and responses in contemporary German picture books. Forty-nine books were identified through systematic searches of two public library catalogs and analyzed using structured content analysis, with caregiver responses classified using the Adults' Responses to Children's Symptoms framework (ARCS). Across books, symptoms were predominantly mild (40.8%) or moderate (46.9%), short-lived, and embedded in everyday contexts; even minor symptoms were typically depicted as disrupting daily routines and accompanied by withdrawal and fear. Accidents (36.7%) and infections (22.5%) were the most common causes, with accidents often framed in terms of personal responsibility (61.1%). Social responses were overwhelmingly supportive, with caregivers and peers providing attention, comfort, and medical help. ARCS-based classification showed a strong predominance of protective caregiving, whereas Encourage/Monitor responses were rare. Overall, the books convey a narrow narrative in which bodily symptoms disrupt everyday life and elicit protection and medicalization. While such portrayals may foster feelings of safety, they rarely depict physical symptoms as transient experiences that resolve without professional intervention, thus missing an opportunity to normalize everyday discomfort and model adaptive self-regulation.