 Headaches, Stomach Aches & Sore Throats: Is it Illness or Anxiety?
By Lee H. McKenzie, RN, MSN, MA and Michael D. McKenzie, MD, FAAP / Family Rhythms
Parents and Kids, February 2006
“Mom, I don't feel well…do I have to go to school today?” When parents hear those words, it is usually early in the morning as they are trying to get their child out of bed, dressed, fed and out of the house on time. The complaint almost always catches parents off guard and in a hurry. The first task is to find out what specifically is wrong before making the decision about school attendance. Fevers, vomiting and significant diarrhea make the decision easy: your child stays home. But what should you do when your child complains about having a headache, stomach ache and/or sore throat? These symptoms are less clear-cut. The most common assumption is that the child is ill, but is that necessarily the case?
Did you know that headaches, stomach aches, sore throats and other physical symptoms can be signs of stress and anxiety? When we were both in our Child Development training program with Dr. T. Berry Brazelton in the early 1980's, he taught us that stomach aches were a universal event for 4 year old girls. He was not talking about stomach aches as a sign of illness; rather, he was teaching us the importance of bodily complaints as signs of worry or dis -ease. Back then we thought he was exaggerating, but through years of pediatric practice, we have come to appreciate his observation and expand on his conclusions. Dr. Brazelton was only half right when he limited his target group to girls; almost all young children complain of stomach aches and other physical symptoms—unrelated to disease or illness—at some time in their young lives.
At this point, you might be wondering what on earth do young children have to be stressed-out or anxious about? They are fed, clothed, cared for and, in the big scheme of life, have very few responsibilities. However, childhood is not an anxiety free state , as evidenced by the dramatic increase over the past few years in the use of powerful psychoactive drugs being prescribed across the country for children as young as 3-5 years of age. In fact, according to one report we read, one in ten children will develop an anxiety disorder. Given the prevalence of childhood anxiety, what signs and symptoms should parents look for with their own child? The most common early signs of stress and anxiety are:
- physical complaints that are not clearly associated with an obvious illness
- changes in basic biorhythms (e.g., sleeping patterns, appetite and eating, level of energy)
- changes in mood, emotional states and overall behavior
Teasing out whether physical complaints are due to illness or stress and/or anxiety is an important place to begin and the first task is to learn to ‘read' your child. Is there an obvious change in the level of physical discomfort which would generally be expected with an illness? Are there repeated complaints that do not seem to fit your expectations that there is an obvious illness? For example, your child has a stomach ache in the morning, but feels much better once you have made the decision that he or she does not have to go to school. Or if you insist on school attendance, the stomach ache disappears when school is over.
Various aches, pain and fatigue are all forms of ‘body talk'. All of our bodies talk to us constantly. While many adults are somewhat ‘deaf' to the sensations of their bodies, young children are often more attuned to what is happening under their skin, because they don't rationalize the sensations away. As parents we need to be open to what is being said by bodily sensations and complaints and interpret those symptoms within the context of our children's lives. The place to begin is to listen in a different way.
A few years ago, we worked with a young girl old who had intermittent stomach aches for several months. Her pediatrician at the time had done an extensive medical evaluation and found nothing wrong with her gastrointestinal system, although he suggested that additional invasive testing could be done. The child's mom wanted another opinion before continuing down the road of expensive, time consuming and uncomfortable medical procedures. When the family came to us, the little girl was still experiencing abdominal pain. Our work focused on establishing a rhythm of conversation between mother & daughter in which there was a regular opportunity for the child to talk about her day. This might seem like a simple intervention and a daily event that occurs in all families, but the difference here is that we asked her mom to listen to the content as well as the emotional tone in her child's conversation.
As is typical for most families, these conversations took place at night getting ready for bed. This tends to be a great time for easy-going relaxed conversation. It also allows children to put the day to rest and deal with any left over worries. Within a few days of relatively unstructured conversation, the reason for the stomach aches emerged: this little girl was troubled by being taken out of her school class on a regular basis for speech therapy! Her mother had no clue that the speech therapy was a problem, as her daughter had told her many times that she liked the therapist. What troubled this young girl, however, was that she felt “stupid” because the other students in the class knew that she needed extra help. Her anxiety over being taken out of the classroom resulted in real physical pain—the stomach aches. Now that we knew a possible cause, the solution was very easy. Her mother let the teacher know that her daughter would not be continuing speech therapy. With this simple intervention, the stomach aches stopped within that same day.
Children may not lead complicated lives, but they lead lives of perceptions, sensations and draw conclusions about their experiences. Sometimes, their perception of events or interpersonal encounters cause them worry or pain. Understanding their perceptions is part of the complex job of parenting and requires the skill of listening beyond the words.
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