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David Baxter

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School-Day Stomachaches: Is The Pain Real?
by Robert Needlman, M.D.
Wed, Sep 05, 2007

You don't have to be a psychologist to figure this one out: Your 9-year-old wakes up in the morning with a stomachache. It's bad - really bad. He can barely brush his teeth. So you let him stay home. Then 10 a.m. rolls around and, miraculously, he feels better! Fine, in fact! He wants breakfast. He wants to play.

It's possible, of course, that he's faking. He might be a gifted actor. Maybe he has a future in the theater. On the other hand, it might be that his stomach really hurts. Often, even when aches and pains have a psychological cause, the pain itself is real.

As a matter of fact, all pain has two parts. The first part comes from actual physical damage to the body. Or, more correctly, it comes from the signals traveling along the nerves that report that the body has been damaged. The second part is made up of the emotions that follow in response to the physical sensations. The main emotion, in most cases, is fear. The brain receives a signal which it interprets as meaning "my body has been hurt," then responds to that signal by creating the experience of fear.

Emotions are not simply ideas floating in space. They have a physical reality, made up of changes in electrical and chemical activity in the brain and in the rest of the body. With fear, for example, the nervous system fires off messages which cause the heart to beat faster, the muscles to tense, and the intestines to slow down. When fear persists over time, the body responds by releasing hormones that cause muscles to break down and the immune system to lower its guard. Some stomachaches start in the stomach, and some start in the brain. Either way, both organs end up being affected. In other words, everything is connected.

Which brings me back to your 9-year-old: At first, it might be hard to know what's going on. If your son throws up and has a fever, a virus is a good bet. Sometimes a serious medical problem starts out with a vague, dull pain in the belly. Appendicitis can start that way. Time will tell. If your son feels just fine as soon as the school bus pulls away, you can put your money on faking, or on anxiety. In either case, the treatment is the same: off to school he goes!

When a child's belly aches or other symptoms keep him home often, or frequently get him sent to the school nurse, then psychological causes are more likely. Ask about bullying; look for learning problems; think about reasons for anxiety. You may have to talk with your child's teacher and with his doctor to figure out what's going on, and what's the best way to help.

Children who have chronic illnesses, such as asthma or sickle cell, often have anxiety symptoms at the same time. It can take patience, persistence, and teamwork (parents, child, doctors, and teachers) to solve the puzzle and help the child. A key is to think about emotional and medical causes together.

Just remember - it's not always a matter of either-or.
 

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