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Understanding the Link between Stress and Stomach Aches in Children

By Dr. Rebecca Cherry

Abdominal pain and stress are related in many ways. Having abdominal pain can cause stress, especially when it leads to missed school or other activities. But more often, stress causes abdominal pain, or makes it worse. Do you ever have “butterflies in your stomach” when you are nervous? Did you ever feel sick to your stomach when you got some bad news? Children feel the same things, but often can’t tell where those feelings come from. It took a long a time to understand why my stomach hurt every morning when I turned the corner to my middle school.

Scientists can explain why we have these feelings: the stomach and intestine have their own nervous system, called the enteric nervous system. These nerves respond to the same stress hormones and neurotransmitters that our brains do. We also know that stress and fatigue decrease pain thresholds. This means that a small change, like the passage of a gas bubble, can feel much worse when a person is stressed, tired, and run down. When a person is well-rested and feeling good, he or she might not even notice the gas bubble.

Stress-related eating can worsen pain, too. Which are the “comfort foods” your child prefers? Are they high in lactose or fructose, such as milk, apple juice, macaroni and cheese, or ice cream? Many people have a poor ability to digest lactose or fructose. Although these conditions are not dangerous, they can be very uncomfortable, causing pain, cramping, bloating, and even diarrhea.

Sometimes, pain and diarrhea indicate intestinal inflammation, especially when there is blood in the stool. Inflammatory bowel disease can cause both pain and stress (imagine having to run to the bathroom a dozen times each day). And inflammation in the body can affect the brain, causing the sorts of changes that make people more sensitive to pain. Fortunately, inflammatory bowel disease is not common in children. If you are concerned that your child might have it, be sure to discuss it with your pediatrician.

So what can you do if your child has pain that is related to stress? Sometimes, a parent can help to figure out the stressor. Maybe it’s that mean kid in the lunchroom. Maybe it’s that sport your child wants to drop but feels he or she can’t. But even when you have identified the stressors, they may not easily be fixed. As we all know, stress cannot be completely avoided. And some stress is even good stress. Instead of getting rid of stress, it is more helpful in the long term for your child to learn to manage it and to recognize when he or she is having physical symptoms of stress.

Medications may be necessary for some kids to control stress and anxiety. But more often, counseling can help, possibly along with other family members. I was also surprised to learn a few years ago that hypnosis can benefit patients with stress-related stomach pain by letting the power of the mind help with physical symptoms. Mindfulness meditation is also a practice that can reduce pain. Best of all, counseling, hypnosis, and mindfulness don’t have any side effects, and they might be helpful in other areas of your child’s life where stress plays a role, besides the stomach pain.

Bottom line: If your child has persistent stomach pain, talk with your doctor. It may turn out to be stress related, and once you know what the problem is, you can find the tools to fix it.

Dr. Rebecca Cherry is associate director of the Motility Center at Rady Children’s Hospital–San Diego and an assistant clinical professor of pediatrics at UC San Diego. She can be reached at