“My Tummy Hurts”: How to Deal with Ongoing “Non-Medical” Pain in Kids
Children can be mysterious beings. As I have written about previously (here and here), it is the job of the adults in a child’s life to be attuned to their little one in order to understand what is needed.
Sometimes this is an easy task. Parents will have moments with their kids where they can tell exactly what is needed (i.e. Oh, they are getting that tone in their voice. That kid is hangry!). However, there will be other moments where a parent might find themselves totally dumbfounded as to what their child is trying to communicate and what they should do.
As a child therapist, part of my role is to help the adults in a child’s life make sense of what is being communicated. One issue that can be tricky to decipher is when children have ongoing complaints of pain but the doctor cannot find anything medically wrong with them. For some families, there may even be a concern that the child is expressing physical pain as a way of avoidance, such as to get out of school or something else that feels daunting to them.
Kids, especially those who are big feelers and tend to internalize, can have very chatty bodies. Some chatty bodies present no disruption in a kid’s routine; a child may tell a parent that they have a stomach ache, get a little extra TLC, and move on with their day. However for other kids, chronic and low-grade pain can get in the way of important activities such as going to school and recreational and social commitments. In my experience, taking the pain seriously and working to understand it are necessary ingredients in resolving it.
The Pain is Real
Whether a child’s pain can be addressed by a medical doctor or not, their pain is real. Children can experience feelings that get located in a body part. For example, a child might complain of a stomach ache but after some exploration we discover that they are feeling scared and anxious and that feeling is expressing itself in the child’s stomach. Even though the child does not have a viral stomach bug, they are truly experiencing discomfort in their tummy.
Because children are symbolic, I tend to be reluctant to apply the pathologizing label of “psychosomatic illness” to a child who is complaining of something like ongoing headaches or stomach aches. Instead, I like to relate to the issue at hand as if the body part is trying to tell us something and it is our job to listen.
(It’s important that I offer the caveat that there are more extreme cases that I’m not including some of these broader statements. Extreme stress in children can cause symptoms such as diarrhea or vomiting. Unfortunately, many adults are quite aware of how stress can affect the body with issues such as migraines, ulcers, and chronic GI issues. However, children should not be under that much stress. If a child or adolescent is exhibiting these symptoms and the doctors are stumped, it is reason to get a therapist involved expediently to try and understand the root cause).
Let’s Do Our Best to Understand What is Happening
It’s important when a child is expressing pain for us to express genuine curiosity and offer open-ended questions. For younger children, one might ask them to draw their pain to provide a visual for us to try and understand better. The limitations of the English language combined with where a child is at developmentally can make it hard for many parents to fully be close to how a child’s body feels.
In some instances, especially those where there is concern that the child is complaining of pain to avoid something, this can be a very frustrating parenting moment. Some parents may even doubt the legitimacy of their child’s complaint. I can recall conversations I have had with parents who are at their wits end after their child has called them from the nurses office, disrupting their workdays and important routines for the fourth day in a row. It is in these moments that a plan is created as the parents and anyone else on Team Kid (including medical doctors, therapists, and allies at the school) continue to get to the root of what is going on.
Come Up With A “For Now” Plan
I am not a behaviorist, meaning I believe that it takes more than behavioral intervention and exposure therapy to help people. However, a “for now” plan can be useful for families to mitigate some disruption while there is work being done to get to the underlying cause of what is causing a kid physical discomfort.
First off, parents should be logging information about their families’ day to see if they can learn patterns or triggers that might relate to the child’s pain. What was happening on good days where there was little or no pain? What was happening on days when the pain complaint arose? Does it happen on certain days or certain times? Is the child looking for anything specifically in regards to their pain? Is there anything we can learn about the root of the stress or conversely what helps a child feel sturdy and fortified?
Secondly, the parent should lay out some clear expectations to the child and leave room for the child to ask questions and express feelings. In the example of a child who is having trouble getting through the school day, identify along with the school, resources the child can use throughout the day to get support and make it through. Be sure to celebrate victories, no matter how small, in a child making it further than they did the day before and try and respond to harder days with support and not disappointment.
Adjust the plan as need. If the child’s pain increases, we may need to lower the bar a little bit to ensure it’s realistic for them to reach it. Or if the current expectations are working well, move the bar up so the child has new growth to stretch to.
Encourage Resiliency But Help Your Child Find Their Limit
One of our main lessons we teach our children as parents is how to be resilient and weather the ups and downs of life. Part of that is learning how to push through discomfort the right amount. Meaning, sometimes we do need to go on with our routine when we feel a little sick. However, sometimes the sick in our bodies is telling us to slow down and that we really do need to rest.
Figuring that right balance between pushing through a little and not pushing through too much takes a good amount of trial and error. It can be a hard enough balance to find for ourselves let alone for a child whose body is separate from yours. Name aloud this lesson and also model for your child when you are a little sick or worn out and pushing through and then when you are sick and resting and taking care of yourself.
