Parents often expect an anxious child to display classic signs of anxiety like excessive worry or fearfulness. But there’s another common symptom that often gets missed or mistaken for something else.
“As adults, we tend to see anxiety as ‘worrying’ in a very cognitive and intellectual way,” clinical psychologist Martha Deiros Collado, author of the forthcoming book How to Be the Grown-Up, told HuffPost.
“So some of the things parents look out for are often words or comments about worries accompanied by tears.”
But kids’ brains are different than ours, she explained, “so when anxiety shows up in their bodies, it is a very physical experience that children often struggle to put into words.”
In kids and teens, anxiety commonly presents as recurring stomach aches. It’s a symptom that clinical psychologist Cindy T. Graham, founder of Brighter Hope Wellness Center, said she often sees in her practice and one that is easily overlooked. (Other symptoms to look out for include appetite or sleep changes, headaches, irritability and clinginess, to name a few)
“Because if a child is anxious about going to school, for example, stomach pains would be reported by the child in the morning. A parent then is likely to attribute this to an illness, or perhaps a response to something their child had for breakfast,” she told HuffPost.
“Don’t be afraid of naming anxiety. In fact, doing so will help your child have a clearer understanding of their emotions and a better vocabulary to communicate those feelings to others.”
Indeed, stomach aches in kids can easily be mistaken for a physical sickness or dietary issues. Children may not realize or be able to verbalize that their stomach discomfort is tied to anxiety.
“This can lead parents, caregivers, and even healthcare professionals to miss the underlying anxiety issue,” psychotherapist Andrea Dorn, author of Calm and Peaceful Mindful Me, told HuffPost.
The connection between anxiety and stomach aches
There are a few potential reasons anxiety often presents as stomach aches in general, and in kids especially. For one, consider the connection between the gut and the brain via what’s called the gut-brain axis. Research has demonstrated a link between the emotional centers of the brain and the gastrointestinal system.
“When a child experiences anxiety, their body may respond by triggering stress-related changes in the gut. Diet, hormones, and mood can all impact the way our digestive system functions and vice versa,” Dorn said. “This connection can lead to discomfort, cramps, and stomach aches.”
The activation of the body’s fight-or-flight response can also lead to “increased blood flow to the muscles and a decrease in blood flow to the digestive system,” said said. “This can cause stomach discomfort. Think ‘fight or flight’ vs. ‘rest and digest.’”
Stomach aches can also be a psychosomatic symptom for kids, especially younger ones, who “may not have the verbal or emotional maturity to express their anxiety through words,” Dorn said. “Instead, their emotional distress may arise through physical symptoms like stomach aches.”
How to tell if it’s a regular stomach ache or related to anxiety
It’s not always easy for parents to distinguish between an anxiety-related stomach ache and a regular one. If your child’s stomach discomfort is persistent or you’re unsure of the root cause, consult a health care professional, Dorn advised.
“They can help rule out any underlying medical conditions and help differentiate between anxiety-related and regular stomach aches,” she said.
Here are some other factors to help you determine what’s going on with your child:
- Look for patterns: Are there certain triggers or stressors that coincide with the stomach aches? “Anxiety-related stomach aches often occur in response to stress, worry, or specific events like school, social situations, or upcoming tests,” Dorn said. Other stomach aches “may not have a clear emotional trigger and could be linked to dietary issues, infections, or other factors.” For example, if your child always has a tummy ache before swim lessons but not other times, “it’s likely they feel nervous about something at the swimming pool,” Deiros Collado said.
- Ask questions: An open and honest conversation with your child can help you suss things out. “Ask them how they’re feeling and if there’s anything on their mind that might be causing stress or worry,” Dorn said. “Sometimes, children may be able to express their feelings and provide insights into the cause of their stomach discomfort.”
- Keep an eye out for emotional indicators: “If the stomach ache is accompanied by signs of anxiety, such as restlessness, irritability, excessive worry, or a heightened stress response, it’s more likely to be anxiety-related,” Dorn said.
- Look for other physical symptoms: Stomach aches related to an illness or dietary problem can be accompanied by other physical symptoms such as fever, diarrhea, vomiting, weight loss or blood in the stool. “Anxiety-related stomach aches typically do not come with these physical symptoms — though in some cases, certainly can be accompanied by vomiting and diarrhea,” Dorn said.
- Take the duration into account: “Anxiety-related stomach aches may come and go in response to anxiety-provoking situations,” Dorn said. “They are often more short-lived and may improve when the child is distracted or feels calmer. Regular stomach aches caused by physical issues may persist for longer periods and may not be as tied to emotional states.”
How to help your kid manage their anxiety
Once you’ve determined your child is likely dealing with anxiety-related stomach issues, the best you can do is to help them understand how anxiety can trick our bodies into feeling unwell, said Deiros Collado.
You can say something like this: “When anxiety shows up it tricks your body into believing something isn’t safe even though it is. It might make your tummy feel funny and hurt, or make you feel a bit shaky. This is your body’s way of trying to communicate that you need some support. When you notice these things in your body you can say ‘I feel anxious’ and once you share that with me I can help you. Anxiety doesn’t have to stick around once we have talked about it and found a solution because it’s done its job, it’s got you the support you needed.”
Don’t be afraid of naming anxiety, Deiros Collado said. In fact, doing so will help your child have a clearer understanding of their emotions and a better vocabulary to communicate those feelings to others when they need support, she said.
“You can also ask your child what they would like to name this feeling,” Deiros Collado said. “Many children enjoy coming up with their own labels, and it can help you as a family to understand when the ‘wobbles’ or ‘bad butterflies’ show up what they are talking about.”
The most effective tools and techniques for managing anxiety will vary from child to child and can shift over time. But for starters, parents should approach their child’s anxiety from a place of understanding and compassion.
“Resiliency can be learned without ‘tough love,’ so parents should provide [opportunities] for the child or teen to talk about their fears,” Graham said.
That being said, be careful not to overvalidate or enable your kid’s worries or fears either, she noted.
Try to strike a balance between being “empathic and encouraging at the same time,” Caroline Miller wrote on the Child Mind Institute’s website.
“For instance: ‘I know that this is really hard and you feel like you’re sick. But we also know that this is anxiety, and you can get through it,’” she wrote.
Mindfulness exercises are a strategy both Graham and Dorn recommended to help kids self-soothe and stay in the present moment.
“These mindfulness moments help children and teens to allow the intense feelings of anxiety to naturally pass by rather than staying focused on them for an extended period of time,” Graham said. “Mindfulness incorporates relaxation, which can be helpful in alleviating increased tension the child is experiencing in the body.”
Dorn is a fan of breathing exercises like the square breathing method: Inhale for four seconds, hold for four seconds, exhale for four seconds and then hold again for four seconds, and so on.
Encouraging creative pursuits such as writing, drawing, dancing and painting are other great ways to help your kids manage stress and express their emotions.
This tool is “particularly helpful for children and teens who may lack the insight to describe in words why they are feeling as they do,” Graham said.
And as a final note, parents should consider limiting exposure to stressful situations, while not eliminating them altogether, Dorn said. Completely removing stressors is a bit like putting a Band-Aid on the issue, she said.
“While it deals with the immediate symptoms, it will not provide a child the skills to deal with future stressors in their life in a healthy and effective way,” Dorn said.
No matter which route you go, it’s important for parents and caregivers to be “patient, flexible and adapt your strategies based on your child’s individual needs and preferences,” Dorn said.
“Working closely with teachers, school counsellors, and mental health professionals can provide a more comprehensive support system for your child,” she said.
“If your child’s anxiety is severe or persistent, it may be necessary to seek the guidance of a mental health professional, such as a child psychologist or therapist. They can provide specialised strategies and techniques tailored to your child’s needs.”