This material is for informational and educational purposes only and is not medical, psychological, or psychotherapeutic advice. If you are experiencing an acute psychological condition or need professional support, please contact a doctor, psychologist, psychotherapist, or crisis service.
A child's stomach hurts before school, and an adult listens without depreciation
On Monday morning, the child has a stomach ache. On Saturday she ran, laughed and asked for a supplement, and before school she turns pale again, curls up in a ball and says she can't get up. Analyzes did not show a dangerous cause. Adults are confused: should they be allowed to stay at home, take them to another doctor, insist on school, or say it's "just nerves"?
The most important thing in this situation is not to choose between the body and the psyche. Pain can be real even when the examination does not reveal structural disease. Stress can affect the work of the nervous system, sleep, breathing, muscle tension, sensitivity of the digestive system, and pain perception. At the same time, similar symptoms may have medical causes. Therefore, attention to emotions does not invalidate the pediatrician, and normal examination results do not mean that the child is making things up.
This article will help you take a broader look at a child's physical complaints: check for safety, see possible patterns, start a conversation without questioning, and understand when a psychologist should be included in the support team.
The material is educational in nature and does not replace the consultation of a pediatrician, psychiatrist, psychotherapist or other specialized specialist. Seek medical attention for new, severe, persistent, or worsening symptoms.
"It's all in the head" is an unfortunate and inaccurate answer
In modern pediatrics, the concept of functional bodily symptoms is used. These are real physical sensations—pain, nausea, dizziness, weakness, palpitations, indigestion—that may be related to changes in how the brain, nervous system, and body interact, rather than organ damage visible on a standard exam.
Three things are important here.
First, the child is not faking just because the tests are normal. Her stomach is really hurting, her heart is really pounding, and the nausea is really preventing her from getting ready for school.
Second, psychological and social factors may influence the onset or duration of symptoms, but are not the only possible explanation. A child can have a chronic illness, exhaustion, anxiety, overload and a difficult situation in the classroom at the same time.
Thirdly, the task of adults is not to guess the symbolic meaning of each pain. The formula "your throat hurts, so you don't speak" sounds convincing, but it is not a diagnosis. It is more useful to examine a specific picture: when the symptom occurs, how long it lasts, what makes it worse, what makes it easier, how the child sleeps, eats, studies and feels around people.
Body, nervous system and environment: one system
Body, nervous system, school and family as an interconnected context
When the brain perceives a situation as threatening, the body mobilizes. The heartbeat increases, breathing changes, muscles tense up, the digestive system may work differently. This is not a breakdown of character, but a normal protective reaction. The problem begins when the alarm system is activated too often, too intensively, or does not return to a quiet mode for a long time.
Let's imagine a schoolgirl who has to speak in front of the class. In the evening, she thinks: "I will forget the words, everyone will laugh." Does not sleep well at night. In the morning, he feels nauseous and spasms in his stomach. Because of these feelings, he is even more afraid: "Something is wrong with me." Anxiety increases bodily response, and bodily response increases anxiety. This is how a circle is formed, where there is no imaginary pain, but there is a mutual reinforcement of feelings, thoughts and behavior.
Another child may have similar pain due to an infection, constipation, food intolerance, or other medical cause. This is why contextual observation complements, not replaces, a medical assessment.
Five similar complaints — five different stories
1. Stomach hurts only before school
Possible questions: is there a test, conflict, bullying, fear of answering at the blackboard, overload, problem with the toilet at school? Does the pain change over the weekend? Is there fever, vomiting, weight loss, defecation disorders?
A useful conclusion is not "it was school that caused the illness," but "there is a recurring morning pattern; let's check the medical security and the school context."
2. After the circles, the head hurts
Dehydration, vision problems, migraines, missed meals, lack of sleep, noise, muscle tension or emotional overload may be the cause. If the adult immediately decides that the child "does not want to develop", he will miss the information. It is better to make a schedule for the week together and see if there is time left for food, exercise, play, silence and sleep.
3. After a family quarrel, the child does not sleep
Even if the conflict took place behind closed doors, the child may notice a change in voices, silence, tension and unpredictability. She will not necessarily tell about the fear directly. Instead, he will ask for water for a long time, come to bed with adults, complain about his heart or nightmares. Calm explanation, restoration of predictability and responsibility of adults for their own conflict are important here.
4. The teenager feels a heartbeat before answering
This may be a sign of anxiety, but new or severe palpitations require medical evaluation. After checking, you can explore the cycle: thought of judgment - tension - racing pulse - fear of passing out - avoidance of response - brief relief - even greater fear next time.
5. The child has a chronic disease and stress at the same time
Psychological support here does not mean that the disease is "from the nerves". Stress can make it difficult to sleep, comply with treatment, perceive pain and adapt to restrictions. A child needs both a doctor's appointment and a space for anger, fear, fatigue and questions about his life.
When you first need a doctor
Do not try to explain the symptom with emotion if it is new, severe, rapidly worsening, or alarming. The immediacy and route of help depends on the specific situation, but special attention is needed:
- severe or localized pain that grows;
- difficulty breathing, fainting, convulsions, impaired consciousness;
- blood in vomit or stools, black stools;
- persistent vomiting, high temperature, severe dehydration;
- weight loss, growth retardation, long-term refusal of food;
- pain that wakes you up at night or persistent nocturnal diarrhea;
- new neurological symptoms, weakness or gait disturbance;
- statements about self-harm, death, or unwillingness to live.
This is not a complete list. If your child's condition scares you, go to the pediatrician or emergency room. It is better to check a dangerous sign than to comfort yourself with the word "psychosomatics".
Case from Dmytro Telushka's practice: "Fix the child"
Dmytro Telushko is a practical psychologist, the author of MriyaRun and RedLines psychological games
An eleven-year-old boy regularly complained of stomach pain, especially in the morning before school. A gastroenterological examination revealed no pathology, and the family heard a brief explanation about the functional symptom and "nerves".
During the psychological work, the picture became wider. The boy was under intense pressure to succeed and lived with the inner demand to be perfect. At the same time, a hidden conflict continued between the parents. When a child was sick, adults for a certain time united around taking care of him. This was not a deliberate manipulation of the boy. His pain was real, and the role of the family "lightning rod" was a working systemic hypothesis that needed to be tested, not proclaimed as a ready-made truth.
The family drew a map: school, expectations, morning situations, the boy's thoughts, body reactions, adult behavior and what happened after the complaint. The focus gradually shifted from "treating only the stomach" to working with the entire context. Parents began to talk about their differences separately and reduced the pressure around performance. Against the background of comprehensive work, the boy's condition improved.
"Parents often come with an unconscious message: "Everything is fine with us, but the child is broken - fix it." But the child lives within an environment that greatly affects him, while his ability to change this environment is limited. The work progresses when adults are able to bear their share of responsibility without taking all responsibility away from the child and without leaving him the sole bearer of the problem."
— Dmytro Telushko, practical psychologist, author of MriyaRun
This example does not mean that every abdominal pain is a family symptom. He shows otherwise: normal analyzes do not complete the research, and psychological work should not be reduced to "pacify the child." Sometimes school workloads, family communication, and the way adults respond to complaints need to change.
How to speak: phrases that open a dialogue
An adult can respond with an attack - "don't make it up" - not only because of indifference. Sometimes it is unbearable for him to see the child's pain and feel helpless. But it is the adult who has more opportunities to withstand this tension, to stay close and not to demand an immediate explanation.
Try these phrases:
"I see that you are not well or in pain now. I'll be by your side. If you can, tell me what it looks like inside."
"Sometimes tension becomes noticeable in the body before we find words for it. What happened before you got sick?"
"Even if the tests did not show a dangerous cause, I believe that you are really struggling. We will think together about what help is needed."
The child has the right to say "I don't know". Then you can stop questioning, but move on to simpler observations: where exactly it hurts, what the feeling is like, how strong it is from zero to ten, what happened before that, what you want now - silence, water, hugs, distance, a doctor or just the presence of an adult.
Phrases that close the conversation
- "Don't make it up. The doctors didn't find anything - there's nothing to hurt there."
- "It's all because of the phone, the wrong food or your laziness."
- "Just calm down, don't think about it, and it will pass."
- "Be honest: you just don't want to go to school?"
- "You have everything because of our quarrels?"
The last two questions are dangerous in their obviousness. The child may agree to please the adult, or feel he has to pick the culprit. It is better to ask: "What is the most difficult thing at school right now?", "When it gets stressful at home, what do you notice about yourself?", "Is there anything else I should know?"
Different age - different language
Preschooler
It is easier to show to a young child than to explain. You can offer to draw a feeling in color, choose an animal that looks like it, or show its size with your hands. It is not necessary to interpret the picture instead of the child. Ask: "Will you tell me about it?"
Younger schoolboy
Specific scales and sequence of events help: "When did it start? What happened ten minutes before? What thought flashed by? What made it easier by at least one point?" This is how the child learns to notice the connection between the situation, thought, emotion, body and action.
Teenager
A teenager especially needs respect for privacy and participation in decisions. It is worth directly asking if he wants to talk to an adult alone, who can be given information and what kind of help is acceptable. Monitoring, reading correspondence, and questioning can reinforce silence, even if the adult is acting out of fear.
Practice for seven days: a map of observations, not a diary of suspicions
Short records help to see patterns and give the doctor or psychologist more accurate information. Complete them together with the child and only with his consent.
Daily note:
- When and where the symptom occurred.
- What was its intensity from 0 to 10.
- Sleep, food, water, exercise and medicine.
- Events before the symptom: school, road, conflict, control, noise, loneliness.
- Thoughts and emotions, if the child can name them.
- What helped or worsened the condition.
- What the child was able to do despite the symptom.
Don't use records as evidence: "You see, you have everything because of school." Their goal is to create a map for collaborative research.
For older teens and parents, the EQ Diary can be helpful: it helps distinguish between emotion, thought, bodily response, and need. This is a self-monitoring tool, not a medical diagnosis.
RedLines EQ: When it's easier to speak through the character
RedLines EQ as a safe conversation about emotion, body, thought, and action through a character's story
RedLines EQ: Emotion Detector provides a safer distance: first, participants talk about the character's story rather than their own conflict. For a child or teenager who is at a loss for words, this can be an easier introduction to the topic.
Real Psychological Board Game RedLines EQ: Emotion Detector by MriyaRun
Dmytro Telushko calls this format a "safe training ground". The rules of the game legalize the conversation about emotions and reactions: instead of intense parental questioning, joint research appears. A child's interpretation of a character's behavior may reveal associations, expectations, and ideas about "how people should behave." This is material for careful listening, not an excuse to catch a child at a projection.
For example, the character has to give a speech in front of the class, but in the morning he has a stomach ache. Instead of "Why are you afraid?" you can explore together:
- what the character feels;
- where it is noticeable in the body;
- what is he thinking about;
- what is feared the most;
- what does because of this fear;
- what support is needed;
- that would help him take a small step.
After that, the adult can ask: "Do you have something similar or is your story completely different?" The words "completely different" give the child back the right not to identify with the character.
"The game is not needed to expose, punish or immediately teach the child the "correct" reaction. It creates a safe polygon and a third point between the child and a difficult topic. Here it is important to listen, endure what has arisen, and gradually help cultivate a different way of thinking. Confronting a child's mind with a complex stress for which it is not yet ready is not support. The child is not yet an adult, even if he really wants to look like one. You don't have to do everything for her, but responsibility should be divided according to age."
— Dmytro Telushko
You can read more about the mechanics of the game in the articles "RedLines EQ: Emotion Detector" and "What is displacement? Defense mechanisms and RedLines game".
MAC "Children of the Dungeon": an insult instead of a forced confession
The child chooses a metaphorical image next to the specialist and talks at his own pace
MAK's Children of the Dungeon series contains 150 images about childhood experiences, fantasies, fears, shame, boundaries, play, pain and resourcefulness. Cards can support externalization—putting the experience into an image that is easier to talk about.
It can be difficult for a child to say, "I'm desperate because of school." Instead, she picks a card and says, "My stomach pain looks like this dark silhouette." This does not mean that the adult has figured out the reason. Then you need open questions:
- What is happening on this map?
- What does the character feel?
- What does he want to avoid?
- Who or what could support him?
- What is similar to you in this story, and what is not at all similar?
- Do you want to continue or should we stop?
Three parts are available for work: "Fairytale World", "Courtyard Childhood" and "Game, Pain and Magic".
Children of the Dungeon MAK Real Deck: Part 1 "Fairytale World"
Children of the Dungeon MAK Real Deck: Part 2 "Courtyard Childhood"
Children of the Dungeon MAK Real Deck: Part 3 Game, Pain and Magic
Limits of safe work with maps
- The child participates voluntarily and can stop at any moment.
- An adult does not interpret the image for her.
- A single card does not prove trauma, abuse, diagnosis, or a specific cause of a symptom.
- The child should not be forced to reveal details for which he is not ready.
- For complex topics, the work takes place next to a child psychologist or psychotherapist who has the appropriate training.
- If a child reports danger, violence or intent to harm themselves, the priority is real protection and professional help, not continuing the game.
The main border passes in the position of an adult. The map itself is neither safe nor dangerous—what matters is what the adult does with the child's response.
The red line is an attempt to make a diagnosis: “Yeah, you chose a terrible monster from the dungeon. So, you have a hidden trauma and you are afraid of your father." Such an interpretation imposes someone else's story on the child, scares him and destroys trust.
Ecological position - an interesting study: "Interesting map. Tell me what this character is feeling right now? What would he like? What in this story is like you, and what is not at all like you?' Here, the adult does not guess or argue, but helps the child build his own story.
If during play the child experiences intense reactions, regularly cries, freezes or panics, and the physical symptoms significantly interfere with sleep, eating, learning or daily life, the game should be ended. Next, the area of responsibility of a pediatrician, child psychologist, psychotherapist or other specialized specialist begins. The tool can shed light on the topic, but is not a substitute for professional help for acute and complex conditions.
Maps can also be useful for parents to explore their own childhood experiences. Sometimes an adult reacts more strongly to a child's tears, anger, or physical complaints because they touch on his own history. Then the question changes: "What happens to me when the child is sick? Why am I in a hurry to deny, save, blame or find a simple reason?”
Responsibility without parental guilt
To see the influence of the family environment does not mean to declare parents the cause of all diseases. Guilt narrows thinking: "I'm a bad mother", "I spoiled the child". Responsibility empowers: "I don't control everything, but I can change the tone of the conversation, the amount of pressure, the way I handle conflicts, and the willingness to ask for help."
It is equally important to leave the child his share of subjectivity according to age. Not to make her a helpless object of treatment, but to involve her in observations and decisions: which doctor is trustworthy, who will be there at the reception, who helps at school, how to tell the teacher when a break is needed.
When should you involve a psychologist?
Psychological counseling can be useful if:
- medical safety is checked, but symptoms recur;
- the child begins to avoid school, friends, food, sleep or usual activities;
- anxiety before the symptom and fear for health increase;
- the family is stuck between devaluation and constant catastrophizing;
- the symptom becomes the only way to get rest, attention or stop the conflict;
- it is difficult for the child to name emotions and ask for support;
- parents need a separate place to work with their fear, conflict, or pressure of expectation.
Sometimes the optimal format is parallel work: a pediatrician or specialized doctor monitors the physical condition, a child psychologist works with the child, and the parents receive their own consultations. These are not interchangeable routes, but a team.
Do not decipher the symptom, but listen to the child
The child, a close adult, a pediatrician and a psychologist as a support team
A child's body can really react to stress before the child learns to explain his condition. But respect begins not with a beautiful interpretation, but with the willingness to remain in uncertainty.
We do not know in advance why the stomach hurts today. We can check for dangerous causes. We can notice the repeated context. We can trust the child without scaring him. We can ask, listen and allow ourselves to not have an answer. We can look at the family and school environment without looking for a single culprit.
That is how, instead of the demand to "fix the child", another task appears: to create conditions in which she does not have to be alone with pain - physical, emotional or mixed.
What to read nearby
Sources of the medical framework
- American Academy of Pediatrics: Helping Children Handle Stress.
- American Academy of Pediatrics: How to Talk With Your Child and Their Pediatrician About Mental Health Concerns.
- Royal Children's Hospital Melbourne: Functional Somatic Symptoms.
- NIDDK: Diagnosis of Irritable Bowel Syndrome in Children.
- NHS: Anxiety in Children.