Somatization

Is your child:

• Having a tummy ache right before a stressful event?
• Experiencing excessive worry about tests and projects to the extent that it impacts performance in the classroom?
• Suddenly feeling sick on the way to school?
• Spending a lot of time visiting the school nurse when he is not sick?
• Feeling fine all weekend but then sick during weekdays?
• Seeming very fragile, always reporting that she doesn’t feel well?
• Having excessive worries leading to headaches, stomachaches or vomiting?

Your child may make frequent trips to the nurse’s office when he is not sick. It may be that you have been to the doctor to check for possible problems with digestion or metabolism and have learned that your child’s health is okay. In this case, it may be that the worries are actually causing these physical symptoms.

Your child’s grades or performance could suffer because she worries excessively about tests, projects, speaking in front of the class, working in a group, or memorizing spelling lists.

It may be that the stomach ache suddenly appears on the way to school when there is a test that day or other exciting event.

You may hear your child say, ‘what if’ a lot. He may be a self-described ‘worry wart.’ You may find that the littlest things make your child nervous.

Children with these challenges tend to have cold hands, pounding heart, tightness in the chest, headaches, and tummy aches. You may see a pattern where the child has these symptoms during more stressful times.

If the child has to perform at a diving meet, music recital, or soccer game, the stomach aches may come on suddenly. When the stressful event passes, your child feels better almost immediately.

You may have the sense that your child is ‘faking sick’ to get out of school. It may be, however, that she or he really feels lousy in anticipation of stressful events and improves quickly when that stressor is removed. Although there is no medical basis for these symptoms, the child may have authentic physical pain or distress.

Anxiety felt within the body and manifested in symptoms like stomach aches, headaches or nausea is called somatization.

When children worry too much, they can have a true physiological reaction. The human body is programmed for survival. To stay safe from predators and other threats to safety, our bodies naturally respond in certain ways to intense anxiety or physiological arousal [1].

When we sense ‘danger,’ our digestive system may temporarily shut off, sending all of our energy to the body parts needed to run away. This response is why people often find their hands get very cold when they are extremely nervous; they may get headaches, tummy aches, and a dry throat [1].

Thus, often, children who spend a lot of time worrying also spend a lot of time in the nurse’s office. It is our job as adults to help them make the connection. Utilizing a clever character called ‘the Worry Monster,’ the book From Worrier to Warrior is a good resource for parents to help their kids understand this connection [2].

Underlying problems that could wind up causing a tummy ache could be performance anxiety, generalized anxiety, academic learning concerns, or social skills deficits. Sometimes, children feel very nervous that they will fail academically or socially.

Children who are intellectually gifted (GT) tend to worry a lot about failure and may have excessive performance anxiety. Anxiety about school could be related to environmental factors like a poor student-to-teacher fit, a climate of bullying or peer rejection, poor self-esteem or low academic self-efficacy. It could also be that although these types of environmental issues impact many children, your child may be genetically and neurophysiologically more anxious than other children.

Academic learning concerns can also cause anxiety. If your child feels unsuccessful or experiences repeated failure in school, these experiences can contribute to anxiety. It will be important to determine whether your child has challenges with reading, writing, math, organization, or focus. It is also necessary to consider whether the performance anxiety exists in other settings.

Does your child become very nervous before a sporting event? Does she struggle with a performance in a choir, band, or drama ensemble? If your child continues to show these signs in various situations, it is likely that he or she is experiencing somatic symptoms.

Does anxiety run in the family?  Anxiety is readily contagious within families, and so it will be helpful to look at your own levels of stress and anxiety and to notice how you cope yourself as a parent.

Model emotional language, and actively engage in coping strategies yourself. Make time for yoga, mindfulness, meditation, etc. Take time for yourself.

Don’t be afraid to implement family activities that are geared towards relaxation, such as an evening walk, exercising together or working on a noncompetitive activity together like a giant jigsaw puzzle.

Identify your own emotions and those in your child. A time when your child is very elevated and restless with stress and anxiety may not be the best time to identify and discuss emotions. In that moment, guide your child to do something to relieve stress.

When it comes to stressful situations like a test at school or performance for dance or a presentation in front of the class, label and describe what anxiety can feel like. Guide your child to be prepared by studying or practicing over the weeks before the stressful event rather than in a cramming sort of manner.

Model and practice deep breathing, getting a good night sleep, and general healthy habits. Help your child recognize that the tummy ache is related to stress. Labeling and recognizing feelings, relaxing and practicing positive self-statements can be helpful.

If these symptoms are too much to manage at home, involve the school psychologist, who may be able to do classroom-based anxiety interventions or to spend time with your child individually. See whether learning concerns are present at school, as these concerns could be impacting anxiety. If learning concerns are present, actively seek support for them, as this support should help ease anxiety. If not, seek out a psychologist or counselor to work with your child on emotion regulation and coping skills. Finally, if symptoms continue to be severe, consider meeting with a child psychiatrist to discuss medication options and the associated benefits and drawbacks.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Intelligence: somatization may be related to giftedness. An individual with an IQ in the top 5% of the population; may be more sensitive and may have performance anxiety
• General anxiety: somatization could be related to general feelings of anxiety. These feelings occur in many contexts, not necessarily just with performance, socializing, tests, etc.
• Learning challenges: somatization could be due to learning challenges. Your child may be nervous before tests because of a cognitive processing or learning challenge related to a learning disability. When school is harder than it should be for your child, it can be anxiety producing
• Social skills challenges (Socializing): somatization may be related to anxiety from social skill deficits, such as trouble reading other people. Sickness around test time may be more to do with the social judgment

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Generalized Anxiety Disorder: excessive worry that has an impact on day-to-day functioning; a number of anxiety disorders, from generalized anxiety to separation anxiety, may lead to somatic symptoms
• Adjustment Disorder with Anxiety (Trauma and Attachment Disorders): anxiety that is related to an adjustment like a change in school placement, new teacher, or being bullied on the playground; a situation that leads to temporary anxiety and may cause somatic symptoms
• Learning Disability may be Dyslexia, Dysgraphia or Dyscalculia (Educationally Identified Disabilities): anxiety related to learning and processing deficits can lead to significant somatic symptoms
• Autism Spectrum Disorder: anxiety related to deficits in social communication that may lead to a preference for routine and repetitive behaviors; can lead to somatic symptoms
• ADHD: ADHD Inattentive Type tends to go along with slow processing as well as losing focus in the classroom, which could lead a student to feel anxious, and somatic symptoms may result
• Medical issue: if your child complains of pain or sickness on a regular basis, it is very important to have a full physical with your child’s doctor before assuming that it is a somatic symptom.

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist
• Psychotherapist or Play Therapist: to treat anxiety and somatization symptoms
• School Psychologist: to treat anxiety in the school setting; to make accommodations for testing with the teacher and team; to address learning concerns; to look at ways to adjust the setting to lessen anxiety
• Psychologist or Neuropsychologist: to consider a full assessment to look at symptoms in mental health context

These professionals may recommend or administer the following tests for this symptom:

• Roberts, BASC-3, Clinical Interview, RCMAS, CDI-2, Human Figure Drawing, Brief Projective Measures: to provide emotional assessment through drawing tasks, questions, interviews, rating scales, and sometimes storytelling
• WISC-V: to establish a baseline of intellectual abilities that can help us understand emotional knowledge and symptoms and determine interventions
• WIAT, WJIV, GORT, TOWL, KeyMath: to establish a baseline of academic skills that can help us understand learning concerns, if any are present, and determine what interventions may work best
• ADOS-2: to consider concerns in social communication and social perspective taking that could indicate an autism assessment may be warranted

[1] Peters, Daniel (February 10, 2014). 10 steps for parents and kids to tame the worry monster. Huffpost Parents. http://www.huffingtonpost.com/daniel-b-peters-phd/10-steps-for-parent-and-kids-to-taming-the-worry-monster_b_4345171.html

[2] Peters, Daniel B. (2013). From worrier to warrior: A guide to conquering your fears. Amazon: https://www.amazon.com/Worrier-Warrior-Guide-Conquering-Fears/dp/1935067249/

[3] Foxman, Paul (2004). The worried child: Recognizing anxiety in children and helping them heal.

Amazon: https://www.amazon.com/Worried-Child-Recognizing-Anxiety-Children/dp/0897934202/

[5] Bender, Janet M. (2004) Tyler Tames The Testing Tiger. (For kids with test anxiety).

Anxiety books for kids:

[4] Zelinger, Laurie & Zelinger, Jordan (2014). Please explain anxiety to me. https://www.amazon.com/Explain-Anxiety-Biology-Solutions-Children/dp/1615992162/

[5] Helsley, Donalisa (2012). The worry glasses: Overcoming anxiety. https://www.amazon.com/Worry-Glasses-Overcoming-Anxiety/dp/1612251641/

[6] Cook, Julia (2012). Wilma jean and the worry machine. https://www.amazon.com/Wilma-Jean-Worry-Machine-Julia/dp/1937870014/

[7] Cook, Julia (2012) Wilma jean and the worry machine: Activity and idea book. Amazon: https://www.amazon.com/Wilma-Jean-Worry-Machine-Activity/dp/1937870030/

[8] Culbert, Timothy &  Kajander, Rebecca (2007). Be the boss of your stress (Be the boss of your body®).

Amazon: https://www.amazon.com/Be-Boss-Your-Stress-Body/dp/1575422565/

[9] Meiners, Cheri J. (2003). When I feel afraid (Learning to get along).

Amazon: https://www.amazon.com/When-Feel-Afraid-Learning-Along/dp/1575421380/

[10] Green, Andi (2011). Don’t feed the worrybug.

Amazon: https://www.amazon.com/Dont-Feed-WorryBug-Soft-Cover/dp/0979286077/

Image Credit:
Description Child with stomach pain
Stock Photo ID: #34696976 (iStock)
By: vitapix
Child Anxiety
Previously Licensed on: November 6, 2016
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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