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By Sunny Sea Gold
September 08, 2008
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Credit: Heather Weston

My older daughter, who’s now 9, started getting regular stomachaches a few years ago, just before starting kindergarten. Her dad and I were confused and worried. Was it constipation? Food sensitivities? Kidney infection? A couple of trips to the pediatrician and a consultation with a child psychologist pinpointed the cause: anxiety. To this day, her stomach tends to act up a little when there’s a significant change or stressor, such as when schools first shut down last spring due to COVID, but now we know how to help her.

Kids’ tummies can hurt anytime, but when pain becomes a chronic problem, it can be truly disruptive to their life and become the focus of your time together. Parents may worry that kids will have more stomachaches now due to the stress of an unpredictable school year, and since we know that nausea and vomiting can be signs of COVID, stomach troubles are more alarming for parents than ever.

Doctors say they haven’t seen an increase in garden-variety stomachaches in young kids during the pandemic, possibly because children are staying at home more. But if your kid is regularly complaining of pain, you may need to play detective in order to suss out the cause, which could be one of three common culprits.

“I’m backed up.”

For Jen Knox, a mother of two in Greenville, South Carolina, a yearslong struggle with her older daughter’s severe constipation started with potty training. “We did day training first and night training later. She always saved her poop for the nighttime diaper, and from around ages 3 to 6, she would hold her poop in for days at a time.” (Her daughter is now 11 and doing fine.)

Most kids feel some level of discomfort about letting their poop out into a toilet rather than their diapers the way they’re used to, says Ajay Rana, M.D., a pediatric gastroenterologist at SUNY Upstate University Hospital. They may hold it in out of fear of the toilet or if they’ve had a painful poop—and then stool gets harder and more painful to push out, which makes them hold it in more. This leads to a vicious cycle of worsening constipation and stomachaches, says Kimberly Montez, M.D., a pediatrician and mom in Winston-Salem, North Carolina. The problem also happens when a child seems to be fully potty trained but then regresses.

Ask your child where it hurts: Constipation pain is often centered in the mid or lower abdomen. And look for streaks in their underwear. Studies suggest that most kids with ongoing constipation have some fecal soiling, which is a sign that stool is backed up in their rectum.

Encourage your child to drink plenty of water. While you can’t control exactly what they eat, you can control what you offer. “Serve a fruit or a vegetable with every meal,” suggests Benjamin V. Bring, D.O., a family-medicine specialist at OhioHealth Physician Group in Dublin, Ohio. “Not getting enough fiber may be one reason that constipation is on the rise in kids.” Add beans—unsalted if possible—and chickpea-based hummus to the menu more often, and serve whole-grain breads. Other good sources of fiber include oatmeal, apples, oranges, carrots, and leafy green vegetables. If your child is a picky eater, consider using an over-the-counter fiber supplement or daily fiber gummies, Dr. Bring says.

It’s a good idea to consult your pediatrician about treatment. For a child who has been constipated for a while, a large amount of hard stool can build up in the rectum and colon. The resultant stretching of the rectum may lead to a loss of urge to poop. Small amounts of laxatives or stool softeners may not be effective in these cases, Dr. Rana says. He recommends a doctor-supervised combination of two over-the-counter treatments: polyethylene glycol (MiraLAX), to make stool softer and easier to pass, and an oral stimulant laxative that triggers the muscles to push the poop out. The medication dosage and length of time a child needs it depends on the severity of symptoms, so don’t try this at home without talking to your pediatrician.

For kids who have a history of constipation, Dr. Montez recommends having a scheduled visit to the bathroom a half hour after a meal and letting them sit and relax for ten minutes. Adding a little humor to the situation can make the experience less stressful. You might read a book or give them a special “potty only” toy to play with. Rewards can help too: Give your child a sticker every time they do a sit-down, even if they don’t poop.

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Credit: Charday Penn/Getty Images

“I’m worrying a lot, over big and little things.”

Just about every morning before school last fall, Veronica Green’s 7-year-old daughter cried because her stomach hurt. Green, who has suffered from irritable bowel syndrome and reflux in the past, worried that her daughter was developing similar gastrointestinal (GI) issues. “Her symptoms were so dramatic that I kept her home from school for three days and took her to see the pediatrician. They did blood work, they took a stool sample, and they found nothing. That’s when the doctor said he thought it was anxiety.”

Tummy troubles related to stress and worry are real physiological problems, Dr. Rana says. “Our gut is heavily lined with nerve cells and connected to the brain. There’s a constant passage of information between them.” The same way that stress can give you a headache, it can also affect some children’s gut health and cause stomachaches, cramps, nausea, and even diarrhea or vomiting.

Look for a pattern. If your child feels sick every night before bed or every morning, they could be anxious about school or another regular happening in their day. If they get nauseated before leaving the house for an outdoor birthday party or a soccer match, they could be worried about feeling left out or messing up and getting embarrassed on the field.

To help soothe your child in the moment, acknowledge that the discomfort they’re experiencing is real: “I know your stomach really hurts right now.” Next, say something like, “It’s totally normal to feel that nervousness about doing well at a sport—and sometimes we feel that in our bellies.” You can gently probe older kids with questions: Are you scared of getting coronavirus? Are you worried that you’re falling behind in school? “Helping kids label and normalize their feelings can release some of the tension,” says developmental psychologist Dawn Huebner, Ph.D., author of What to Do When You Worry Too Much.

“Relaxation strategies adults use like breathing or mindfulness keep you focused on your body—but when a child has physical symptoms, it might not be helpful to keep them focused that way,” Dr. Huebner says. “Instead, help them find a distraction like drawing, playing with their pet, or shooting baskets.” Physical activity can be particularly helpful, she says: “When kids are anxious, there’s a release of adrenaline and cortisol, and doing something active can burn that off and help them feel better physically.” If the stomachaches don’t improve, ask your pediatrician about a consultation with a mental-health professional.

mother holding toddler kissing hand
Credit: Anna Wolf

“I can’t digest what you’re feeding me.”

These days, parents can be quick to suspect that their child’s GI problems are related to something in their diet—and they may be right. “In infants, it’s often a cow’s milk allergy, but other intolerances, most commonly lactose intolerance, start to arise around age 4 or 5,” Dr. Rana says. “Animal babies drink milk, and as they get older, they never go back to drinking milk. As we grow up, we’re not supposed to be heavily dependent on milk either—and so many kids develop trouble digesting lactose, the naturally occurring sugar in milk.”

That was the situation Ashley Bass, a mother of two in Durham, North Carolina, found herself in several months ago when her then 4-year-old son started complaining almost daily of stomachaches. She and her husband suspected milk was the culprit because he’d had a milk allergy as a baby, although he’d grown out of it, and because severe lactose intolerance runs in the family. “We cut back drastically on dairy, and when he had pain and gas, we traced it back to dairy ingredients every time. We have now completely cut dairy out of his diet and are seeing a big difference.”

Another common issue Dr. Rana sees is celiac disease—an autoimmune disorder in which a person’s immune system attacks their digestive system when they eat gluten, a protein found in wheat, barley, and rye. It causes stomach pain as well as bloating, diarrhea, decreased appetite, and sometimes weight loss and poor growth in kids. Your child can be screened for celiac with a blood test but might need an endoscopy to confirm the diagnosis; the main treatment is a gluten-free diet. “But then there is gluten ‘sensitivity,’ in which a child tests negative for celiac but still seems to be bothered by gluten,” Dr. Rana says. “I don’t deny the existence of this sensitivity, but it’s very difficult to say who has it when there are no tests for it yet.” He hesitates to put children on a gluten-free diet if it’s not absolutely clear they need it, since foods like whole wheat are also very rich in fiber, vitamins, and micronutrients. “Parents tell me that their child has symptoms after eating bread. But this is often related to lactose—if they’re eating a burger, pizza, or pasta, there’s often lots of cheese. I always tell parents to try cutting out lactose first, using lactose-free milk and fortified plant-based alternatives to dairy, and see if that makes a difference.”

Don’t restrict your kid’s diet without checking in with your pediatrician first. “By the time a child has been referred to our clinic, their parents may have cut out multiple foods,” Dr. Bring says, which can make it trickier to identify the issue. As a first step, your doctor may ask you to keep a food diary for a week or two and track your child’s GI symptoms, then make another appointment and bring the details to your next visit.

This article originally appeared in Parents magazine's November 2020 issue as “What’s Your Child’s Stomachache Trying to Tell You?” Want more from the magazine? Sign up for a monthly print subscription here

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