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When It's More Than a Tummy Ache

What parents need to know about anxiety-related abdominal pain

Published on: February 07, 2019

Child with stomach ache

It’s not uncommon for kids to complain of abdominal pain around the start of the school year or before a big test, sports game or performance — when their stress and anxiety levels can be at an all-time high.

While this may not be a cause for immediate concern for some parents, others may feel uncertain about how to address their child’s pain, or may not know that there could be more to it than just a few "butterflies" fluttering in their child’s stomach.

Dr. Nicole Sawangpont Pattamanuch, a gastroenterologist at Seattle Children’s, breaks down the symptoms of abdominal pain related to stress and anxiety; recommends coping techniques for kids to alleviate their discomfort; and shares red flags to help families determine if there is something more concerning about their child’s symptoms.

This excerpted post was originally published on the Seattle Children's On the Pulse blog
Seattle Children's

Breaking down the differences in symptoms

According to a study in the peer-reviewed scientific journal PLOS One about pediatric functional abdominal pain disorders, chronic abdominal pain is a common problem in childhood, with prevalence rates ranging from 0.3–19 percent in school-aged children in the United States and Europe. However, in almost 90 percent of these children, there is no diagnosable disease tied to their symptoms.

“People with functional abdominal pain have a hypersensitive nervous system, due to early life adverse events, previous surgeries, acute infections or food intolerances,” says Pattamanuch.

“If we think of the brain as a stereo receiver and speakers, it helps us understand how the gut-brain axis works. The gut reports pain to the spine, which relays the pain signals to the brain. Children under stress, whether of a physical or emotional nature, will often have the volume dial turned up on their stereo receiver. How the brain receives and interprets the pain signal is highly tied to our emotional state.”

In Pattamanuch’s practice, she sees many children with functional abdominal pain.

“These kids are still eating and gaining weight normally. They may experience pain, but overall they are functioning well, going to school and sleeping at night.”

In an initial visit with a child who is facing abdominal pain issues, with symptoms such as constipation, diarrhea, nausea and/or vomiting, Pattamanuch always starts by asking parents if they think stress is a factor. This encompasses home, school and social stressors.

“Around half of the parents I meet with are usually aware that their kids are undergoing a lot of stress but are simply doing their due diligence to make sure they’re not missing any underlying medical issues their child may have,” says Pattamanuch.

“The other half may not have a sense that their child’s pain is connected to stress, even though I’m concerned there are indeed psychological issues present. In these cases, it’s important that we investigate further and consider getting a counselor involved to screen for stressors.”

While not as common, Pattamanuch says the red flags that may signal there is an underlying disease present involves children presenting symptoms such as weight loss, persistent vomiting and diarrhea, or blood in their vomit or stool.

“Symptoms that are causing severe dysfunction are a huge cause for concern,” says Pattamanuch. “At this point, it’s very clear that they need to be medically evaluated as soon as possible.”

Coping techniques and resources to help kids thrive

With functional abdominal pain, there isn’t necessarily a definite treatment or medication that will cure kids’ discomfort.

“It’s more about helping these kids learn coping techniques and identify the triggers that exacerbate their symptoms,” says Pattamanuch. “Children may need more screening for depression or anxiety from a mental health professional. There are helpful clinics at Seattle Children’s for this.”

Some kids may be referred to the Biofeedback Clinic, where they can learn relaxation techniques to decrease the intensity of their pain. They may also be referred to the Pain Medicine Clinic where they could undergo an in-depth assessment to help manage their pain.

Aside from these resources, Pattamanuch often works with kids on simple techniques they can practice at home and implement into their daily lives to alleviate their recurring abdominal pain and discomfort. These include:

  • Peppermint: Brewing a cup of peppermint tea can help soothe the stomach and alleviate feelings of nausea.
  • Practicing mindfulness: Resting in a quiet room and listening to the sound of their heartbeat and breathing can allow kids to tune out stressors that are running through their head. It can also help bring down their blood pressure and heart rate.
  • Regular exercise: It’s common for kids to withdraw from being active due to discomfort. If they become more isolated, it could make them feel worse. Pushing through their symptoms to continue their physical activities is important. Daily exercise can help kids release their stress, be more alert during the day, perform better in school and sleep better at night.

While all kids have unique needs, some may require medication to help alleviate their symptoms. However, Pattamanuch says there’s careful consideration when offering this treatment.

“When needed, we have some medications we can prescribe to help relax the gastrointestinal tract, but often they aren’t useful because they’re not addressing the root cause of the issue,” she says. “It’s most beneficial for kids to learn how to get in tune with their psychological triggers and try to address those issues, first and foremost.”

To assist in properly evaluating their child' issue, Pattamanuch recommends parents do the following:

  • Keep a food diary: Logging the food their child eats, along with the times their child feels discomfort, can help troubleshoot whether it’s related to things like too much dairy intake or unhealthy eating, among other factors.
  • Think about the psychological stressors: This could be anything from school and academic work to bullying or changes in the family structure.

“I don’t think we talk enough about the important connection of our minds to our ‘bellies,’” says Pattamanuch. “The more we educate families on how it works, the better the chances are of kids being able to learn the coping skills needed for them to live happy and healthy lives.”

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