The “back-to-school” stomach ache

Q: Why do so many kids get a stomach ache at the beginning of the school year? Is it all just anxiety?boy-694763_960_720

A:  Returning to school can be a stressful time especially for kids who are starting in a new place. And yes, stress and anxiety can cause a stomach ache. (I distinctly remember the crampy pains I would get every morning on the way to middle school.) Stress can lead to changes in the rate that food passes through our bodies, in the production of hormones important for digestion, and in gastric acidity. It can also worsen the pain from other GI problems which are not stress-related. Here are some possibilities to look out for.

Change of diet. A lot of kids eat differently during the school year then during breaks, especially when a quick breakfast becomes a priority or when they eat school lunches. For instance, if cereal with milk is the convenient school day breakfast, your child may be showing symptoms of lactose intolerance. Drinking juices or sweetened drinks at school might be causing symptoms of fructose malabsorption. Students also share food with each other, so you might want to ask about items that you may not have in the house.

Holding it.” Most children do not like to have bowel movements at school, for a whole range of reasons. Withholding stool can then turn into a habit, although an unconscious one, which leads to a stomach ache. Having food in the stomach will often promote a bowel movement, so it can be helpful to designate 5 to 10 minutes after dinner as “Toilet Time.”

Allergies. Here in San Diego we are exposed to pollen and other airborne allergens all year round. One of the functions of our nasal lining is to create mucus which grabs onto those allergens. That mucus has to go somewhere – and most of it goes down our throats, without us even noticing it. There are a few consequences to swallowing that mucus. One is that when we wake up in the morning all the night-time mucus in the GI tract can cause some nausea or discomfort. Another consequence, which is less common, is that the allergens in the mucus irritate the lining of the esophagus. The irritation is typically most severe where the esophagus meets the top of the stomach. This condition, called eosinophilic esophagitis or EoE, can cause abdominal pain which is sometimes seasonal.

Disordered eating. When kids go back to school, especially during the preteen and teen years, they can be very self-conscious about the changes in their developing bodies. Sometimes healthy, normal sized kids compare themselves to their peers or their media role models and decide that they are too heavy. When a kid starts cutting down on food or missing meals saying that they have a stomach ache, it may be that he or she is trying to avoid eating. Similarly, they may say that certain foods bother them, or start avoiding whole food groups (like carbohydrates). These sorts of big dietary changes may be signs of an impending eating disorder rather than a food intolerance.

Most stomach aches from typical back-to-school jitters will go away within a few weeks, as the academic year gets underway. However, if abdominal pain persists, you should discuss it with your pediatrician. If needed, expert GI consultation is available here at Pediatric Specialty Partners.