“Mommy, I have a tummy ache.”
It’s a sentence every parent will hear from their child sooner or later. Usually, with simple home care and rest, the tummy ache will quickly pass.
But in some cases, stomachaches and other symptoms–such as frequent headaches, recurring nausea, diarrhea, dizziness, sweats and flushing–keep returning. Physical causes, from bacteria to viruses to food allergies or even lactose intolerance, are often the trigger. However, if the pediatrician has performed a thorough exam and found a child in good health, it’s possible that underlying anxiety is setting off the complaints.
It’s well known that emotions can profoundly alter our physical state. Our heart races when excited and pounds when angry; our faces flush deep pink when embarrassed; goose bumps rise all over our skin when we are moved to awe; our palms go slick with sweat and butterflies flutter in our stomachs when afraid. Each emotion causes a complex cascade of chemicals that leads to profound physiological and neuroendocrine changes. It is not surprising then, that chronic anxiety can give rise to ongoing physical complaints.
What are “somatic symptoms”?
Chronic symptoms arising from emotions such as anxiety or depression are called somatoform–they are ailments for which no organic or physiological cause has been found. On average, about a quarter of children and adolescents from ages 2-17 years old experience somatic symptoms every week or two. This might include restlessness, stomachaches, flushing, palpitations, sweating, headache, fatigue, dizziness, nausea, difficulty breathing, and muscle tension or pain. For the majority of children, these symptoms are short-lived and are not cause for concern. But for some vulnerable children, the complaints are ongoing and disruptive, interfering with daily life.
Frequent somatic ailments can lead to missed days at school, and numerous visits to the pediatrician. The actual physical symptoms likely present no risk, but the intense worry they generate for both child and parent can be draining.
Research has found that nearly every child with a diagnosed anxiety disorder reports at least one somatic complaint, and many of the children report several. Among youth aged 11-17, girls are significantly more likely to experience somatic symptoms due to emotions. Children who have experienced divorce or loss are also more likely to experience these symptoms. They are often worriers and fearful of new situations.
Treating the symptoms
Initially, one can treat somatic complaints such as a headache or nausea with familiar home or over-the-counter remedies. Peppermint or chamomile tea can help soothe a nervous stomach, and just having a parent prepare a comforting drink may go a long way towards easing anxiety symptoms. Dry crackers, toast, yogurt, or any comfort food may also help. Remedies found at the drugstore, such as Alka-Seltzer, Mylanta, or Pepto-Bismol can soothe a stomach as well. Headaches can be treated with ibuprofen or acetaminophen. However, these medications should be used carefully for an acute and passing issue, and not on a regular or long-term basis unless instructed by a doctor.
Addressing the underlying cause
Over the long term, underlying anxiety can be effectively addressed through techniques such as cognitive reframing, emotion regulation, and mindfulness exercises.
First, it’s useful to address a child’s anxiety over internal physiological cues. Increased anxiety as well as somatic symptoms have been correlated with a greater capacity to notice sensations and ordinary bodily functions such as a heartbeat. In fact, heartbeat perception—the ability to perceive and notice one’s own heartbeat—is enhanced in children with anxiety sensitivity. Anxiety sensitivity is the actual fear of the sensations that accompany anxiety, such as a pounding heart, breathlessness or nausea. Children who can accurately count their own heartbeats, without taking their pulse or holding their breath, tend to score significantly higher on both panic and somatic symptoms. It may be that such children are more sensitive to their own bodily sensations and have an enhanced ability to perceive internal cues. It may also be that their anxiety causes them to pay more attention to their bodily sensations.
In either case, learning how to regulate emotions about the body can help. The ability to recognize, understand, and regulate emotions is key to helping control anxious thoughts. Children and adolescents with somatic complaints have been found to have a harder time interpreting the physical signals that naturally arise from emotions. They also often have a harder time expressing and verbalizing negative emotions. It is important for parents not to be dismissive of children’s emotions, but rather, to encourage them to discuss the whole rainbow of different feelings openly. This can help shift their focus from internal sensations and states. Parents are taught ways to improve their own emotional awareness, increase empathic responses to their children’s emotions, and minimize dismissal of children’s emotions. This has been shown to improve a child’s somatic complaints.
How kids can help themselves feel better
There are many things that kids can try for themselves to help reduce somatic complaints:
- Get moving. Physical activity and exercise can help burn off excess energy, including anxious energy, and has been linked to better mood and sleep. Studies have shown that exercise programs lead to clinically significant reductions in anxiety
- Cognitive reframing. Help a child reframe and reinterpret some of the symptoms that accompany anxiety. For instance, we sweat and our hearts pound and race when we exercise, but we can interpret that physiological arousal as good and welcome.
- Diaphragmatic breathing. Ask a child to close her eyes and take a deep breath, and slowly exhale. Continue to slowly breathe in and out, deeply, while watching the breath. Slow diaphragmatic breathing can become a daily practice, morning and evening for ten or fifteen minutes, to help re-set the nervous system from fight-or-flight to calm-and-connect.
- Mindfulness. Mindfulness exercises have been shown to significantly reduce somatic symptoms across time. Teach a child to mindfully observe panicky symptoms, such as rapid breathing, dizziness, pounding heart. These are bodily sensations no different than an itch or an odor. A child can learn to let the symptom “be”, while simply bringing attention to the breath. One important insight gained from mindfulness is that experience, sensation and mood tend to change. Each thought, sensation or emotion is like a cloud drifting across the sky. Soon another cloud will take its place. Taking a mindfulness approach, the above approaches may help to lessen sensitivity to the body’s normal responses, and manage anxiety as well as anxiety sensitivity.
Somatofom disorders: 30 years of debate about criteria! What about children and adolescents? Ilva Elena Schulte, Franz Petermann
Somatic Symptoms in Children and Adolescents with Anxiety Disorders Golda S. Ginsburg, Mark A. Riddle, Mark Davies
Heart-beat perception, panic/somatic symptoms and anxiety sensitivity in children. Thalia C. Eley, Lucy Stirling, Anke Ehlers, Alice M. Gregory, David M. Clark
Mindfulness therapy for somatization disorder and functional somatic syndromes — Randomized trial with one-year follow-up Lone Overby Fjorback, Mikkel Arendt, Eva Ørnbøl, Harald Walach, Emma Rehfeld, Andreas Schröder, Per Fink
Somatic Complaints in Early Adolescence: The Role of Parents’ Emotion Socialization Christiane E. Kehoe, Sophie S. Havighurst, and Ann E. Harley