Your child’s stomachaches, headaches, and other physical symptoms could be related to stress.
The brain is incredible. It knows what we don’t “know”. Or when we don’t pay attention, the brain will work with the body to send information to get our attention.
Have you ever noticed signals from your body when you are under stress? Illness, tension headache, back pain, stomach upset, and even frightening symptoms like heart palpitations can be related to stress. The list of ways your physical body can manifest stress includes nearly every system of the body. These are called somatic symptoms, or “somatization”. These are normal symptoms until they get in the way of everyday life.
When a child (or adult) experiences persistent or concerning physical symptoms, the first step is always to consult with your medical provider(s). You need a professional to complete any necessary medical exams, laboratory testing, and/or procedures to be clear that there is not a medical cause for the symptoms.
Somatic symptoms are real.
They are not imagined or fake. And they can be disruptive, painful, and scary. Somatic symptoms are signals from the brain (unconscious mind, actually) when the body needs to communicate psychological distress. If you think about it, it’s actually something to be thankful for because chronic, untreated psychological distress can increase risk for very serious medical diseases. Science has left no doubt about this.
The purpose of somatic symptoms associated with stress is to alert you and your child to do something different.
Something (or many things) need to be done to reduce factors that contribute to psychological distress. And the child’s understanding, beliefs, and perceptions about the somatic symptoms may need to change. Maybe yours too? Somatic symptoms become really problematic if our response to them reinforces them (making them stronger, reoccurring, or long lasting), and when we don’t improve the things contributing to our psychological distress.
Treatment that addresses the relationship between the mind and body is critical to improving somatic symptoms.
Here are fictious examples:
Andre hates math tests. And they occur every Thursday morning. His mind goes blank during the test and he can’t think! Then he starts guessing answers so the paper isn’t blank. Sometimes he gets tearful and other times he gets angry. The teacher gets upset with him when he gets disruptive and he recently lost recess time. Andre had failed several math tests by September. He tells his parents that he “hates math”. His parents keep telling him that he needs to practice more but Andre is resistant to homework and especially doing anything extra.
By November, Andre is getting stomach aches in the mornings before school. He has to go to the bathroom repeatedly for diarrhea. He starts missing the first class (math) because it’s hard to leave the house until his stomach settles down. His parents start to really worry about absences and the make-up work he has to do at home. They know that Andre is not faking his stomachaches because he has visible, clear symptoms. They feel stuck! What horrible timing that he gets sick at a time when he needs to be at school most. His grades in math are now suffering. They decide to visit the pediatrician and her exam is normal; they decide to monitor the symptoms.
Andre’s family meets with the school team to discuss their concerns. First, overwhelm with math tests. Then failing grades and resistance to homework. Then behavior problems. Then stomachaches. Then school absences. More low grades. What do we need to do?
The school team looks carefully at his classwork and prior school records, and realize he needs to be evaluated for a possible math learning disability. He also needs small group help with the Early Intervention Program. The school counselor decides to meet with Andre to talk about his overwhelm. She gives him strategies to try before math tests, including writing in his worry journal at home and belly breathing exercises in the classroom just before the test. With increased awareness about his anxiety around math, extra instructional help from teachers, extended time on testing, and strategies to cope better, his stomachaches get better. Andre (and his family) begins to realize that when he gets overwhelmed, his body experiences stomachaches.
Now, Andre’s story is a pretty obvious example about somatic symptoms. But when a child and family are living in the middle of it, it’s really difficult to see what can be obvious to others.
Read this example to see that it’s not so easy to recognize somatic symptoms for some children:
Tamara is an 11 year old girl who has a complex medical history. She was born premature and she has heart disease that required a surgery as an infant. She had several seizures when she was little but these resolved. Tamara is incredibly resilient and has done really well throughout development. She makes all As at school. She loves gymnastics, art, and she is a social butterfly. Tamara would like to be a doctor when she grows up. Her family and teachers praise her for her “intelligence” and “talent”. Tamara is ready for 6th grade!
The beginning of 6th grade starts off okay. Tamara is working hard, making new friends, and juggling homework and competitive gymnastics. Some nights she doesn’t get a lot of sleep because she is studying after gymnastics. Unfortunately, Tamara gets an injury and has to miss a couple months while her ankle heals. She slowly starts to return to physical activity but the pain in her ankle does not go away. Tamara decides to continue because there is a competition coming up. Meanwhile, Tamara starts to experience changes with her friendships at school. She notices that her girlfriends are being mean and excluding her. Tamara starts to distance herself from them. She focuses on her studies and keeps making straight As.
Tamara’s gymnastics competition is here! She has been reassured by the doctor that her ankle is fine, and she is ready for strenuous activity. Tamara is all dressed and ready to go. But as she approaches lines up for the competition event, she feels her heart rate speed up. She can feel it pumping in her chest. She wonders, why?! And then she wonders if it’s related to her heart condition. She gets scared because her heart won’t stop. What if it gets worse while dancing? Tamara starts crying. She calls her parents from the audience to tell them. Her parents get scared too. They decide that Tamara will not compete and will go home and rest. She takes all day Sunday to rest, watch movies, and prepare for the next seek.
The following month, Tamara has another episode where her heart starts beating really fast and hard at school. This happens while she is about to go to the cafeteria for lunch. She goes to the nurse’s office and gets dismissed early. The week after, she has another episode while trying to fall asleep at home. Tamara visits the cardiologist and has extensive cardiac testing. The cardiologist assures her that her heart is doing great and the heart palpitations are non-cardiac. He says they are likely related to stress and recommends that Tamara start counseling.
Counseling reveals that Tamara is under tremendous stress! She tends to be a perfectionist, putting too much pressure on herself. Tamara realizes that she feels lonely since her friendships have changed in junior high. And she begins to recognize that she doesn’t love gymnastics as much as she use to. Tamara is also not getting enough sleep. She decides to take a break from gymnastics and join an art club to meet new friends. Tamara works with her therapist on her “black and white” thinking about what it means to be “intelligent” and “talented”. Slowly over time, Tamara notices that the pain in her ankle is less noticeable. Her heart palpitations still occur every once in a while, but when they occur, she knows her heart is healthy. She knows it’s related to stress and tries strategies her counselor is teaching her. Tamara closes her eyes, imagines herself watching the waves at the beach, and breathes deeply.
As you can see, even children with known medical conditions can show somatic symptoms that could appear to be related to the medical condition.
Both of the examples provided above show somatic symptoms that emerged and improved over a brief period. More commonly, somatic symptoms that are problematic are prolonged and families spend a long time working with medical providers figuring out the cause.
What if you suspect possible somatic symptoms in your child?
Talk with your pediatrician or medical specialist(s) about the symptoms and follow up on any testing they recommend. If you are not satisfied with the opinion of a general physician like a pediatrician or family care doctor, see a specialist who has expertise related to your child’s symptoms (e.g., orthopedist, neurologist, cardiologist, etc). Be patient because this stage of figuring out the physical symptoms can take a while. If all medical testing confirms no medical cause…
- Make note of other concerns such as the following:
- Sleep (too much, too little)
- Appetite (too much, too little)
- Low energy level
- Reduced enjoyment in typical things
- Depressed mood, anger, irritability
- Withdrawal, loneliness, sadness
- Oppositional or risk taking behavior
- Worry, anxiety, fearfulness
- Inflexible, obsessive thinking or behavior
- If relevant, talk with the school team. Is there anything you need to know? Any teasing, bullying or peer conflicts? What about classroom performance and behavior? What about a coach? Is your child visiting the school nurse? How many school absences due to physical symptoms?
- Depending on your child’s cognitive, verbal, and emotional abilities, a conversation with them about current stressors, emotions, and physical symptoms could be revealing. But don’t be surprised if your child doesn’t know what to say. Reduced self-awareness may among the reasons why the somatic symptoms occur.
Schedule consultation with a counselor or psychologist who understands somatization. Make sure this clinician will also work with family. As parents, you need to know HOW to support your child at home. To find a counselor, start by calling your insurance company and asking about pediatric mental health providers in your area. Search their names for a website to learn about their practice and specialization. Then call them about getting scheduled!
Also visit the American Academy of Child & Adolescent Psychiatry to read more,
Physical Symptoms of Emotional Distress: Somatic Symptoms and Related Disorders
You might also find the following resources to be helpful:
