Somatization and Anxiety

This article was written with contributions from Hannah Larson LPC. She is a Pediatric Therapist and LPC.

What is Somatization in Childhood?

Somatization in childhood is emotional upset felt within the body and manifested in physical symptoms like stomach aches, headaches, or nausea. The child is experiencing real physical symptoms for which there is no medical explanation. 

Your child may make frequent trips to the nurse’s office when not physically sick. 

It may be that you have been to the doctor to check for possible problems with digestion or metabolism and have learned that your child’s health is just fine. In this case, it may be that the worries or other emotional issues are causing these physical symptoms.

You may have the sense that your child is ‘faking sick’ to get out of school. However, they may feel lousy in anticipation of stressful events, and feelings may improve quickly when a stressor is removed. Although there is no medical basis for these symptoms, your child may have significant pain or physical distress.

Symptoms of Somatization in Children

• Stomach ache on the day of a big test, performance, or game: your child does not feel well when there is an expectation to perform well at an upcoming event 
• Visiting the school nurse but not sick: your child is often in the nurse’s office for stomach aches and feeling nauseous but there are no medical issues or illnesses to explain the symptoms
• Suddenly feeling sick on the way to school: your child has been feeling great all weekend and then suddenly fell ill on the way to school 
• Excessive worry: your child is constantly worried and feels symptoms physically with shortness of breath, butterflies in the stomach, dizziness, headaches, and other symptoms. Some kids may have panic attacks when this happens
• Reports being sick all the time: you are constantly visiting the doctor for fear your child may be sick, but there is no medical explanation
• Saying ‘what if’ constantly: your child is saying ‘what if’ all the time,  and anticipating the worst happening. Your child’s muscles are tense, and their body is in knots over the stress
• Sudden tummy aches: your child has to perform at a diving meet, music recital, or soccer game, and their stomach aches, they feel nausea, or an upset tummy comes on suddenly. When the stressful event passes, your child feels better almost immediately

Causes of Somatization in Childhood

Too much worry

When children worry too much, they can have a physiological reaction. The human body is programmed for survival. To stay safe from predators and other threats to safety, our bodies naturally respond in specific ways to intense anxiety with physiological arousal [1].

When we sense ‘danger,’ our digestive system may temporarily shut off, sending all of our energy to the body parts needed to run away. This response is why people often find their hands get very cold when they are extremely nervous; they may get headaches, tummy aches, and a dry throat [1].

Sometimes worry can be related to medical conditions like functional abdominal pain or irritable bowel syndrome. A child’s experience may be stomach pain, and excessive worry could contribute to the condition. With stomach pain, it is also essential to rule out food allergies as these might be mistaken for anxiety but a medical doctor can help if you have this concern.

Performance anxiety

When your child is worried about how they will be perceived or how they measure up to their own standards they can experience anxiety that includes somatization. Think of the actor vomiting in the bathroom before they go onstage. Performance anxiety is a real issue and trends toward physical anxiety. Children may feel dizzy, nervous, tense, and may have a headache or stomach ache. It can be even scarier if your child thinks they are sick and start to worry about the doctor’s office or getting a shot. If they can recognize the physiological anxiety for what it is, they are likely to be able to manage it.

Academic learning concerns

School problems can cause anxiety. If your child feels unsuccessful or has experienced repeated failure in school, anxiety may result. It will be essential to determine whether your child has reading, writing, math, organization, or focus challenges that can be supported in school. If your child feels successful academically, anxiety may go away or drastically decrease. 

Social skills deficits 

When a child struggles to make friends, anxiety can come up. Perhaps your child is trying very hard to make friends, but things are not going well with peers. For example, children with autism or ADHD may struggle with social skills and be unaware of how their behavior is impacting those around them. They may become anxious as they want friends but are not aware of how to make and keep friends. These challenges may lead to somatization in the form of tummy aches or illness when confronted with a crowded cafeteria or playground.

Giftedness 

Intellectually gifted children tend to worry a lot about failure and may have excessive performance anxiety. Their tendency to be anxious often leads to somatic symptoms like tummy aches and headaches.

School anxiety

Anxiety about school could be related to environmental factors like poor student-to-teacher fit, a climate of bullying or peer rejection, poor self-esteem, or low academic self-efficacy (the child’s belief that academic success is possible). It could also be that although these types of environmental issues impact many children, your child may be genetically and neurophysiologically more anxious than other children.

Trauma or stressful events

When kids are worried about events happening in their life, such as the death of a loved one, parents divorcing, unsafe childcare, or being bullied among other environmental factors, they will not feel well. Your child may experience these traumas as physiological anxiety. 

Generalized anxiety

Generalized anxiety is a pervasive and consistent feeling of worry that is not easily managed. Children who worry so much that it impacts their daily life may have a mix of cognitive symptoms and physiological symptoms. This means that they may have a way of thinking that contributes to worry, and they may also feel worried in their bodies. It is important to remember that worries can be learned. For example, some children are picking up on all the worries of the adults around them. 

Panic disorder

Panic includes physiological anxiety such as a severe attack of sweating, nausea, racing heart rate, dizziness, chills, and chest pain. Panic symptoms often lead to more anxiety because the individual is afraid that the panic could happen again.

Conversion disorder

Extreme neurological symptoms that have no medical cause, often following trauma or extreme anxiety, can be classified as conversion disorder. Some children find they cannot walk, fall or faint frequently, or feel phantom pain. This struggle is a very extreme and uncommon result of somatization symptoms. It is essential to help your child recognize and cope with anxiety so that it does not escalate into something more serious.

Top 15 Ways Parents Can Help Reduce Anxiety and Somatization

1. Be a good example:  Anxiety is readily contagious within families, and so it will be helpful to look at your own levels of stress and anxiety and to notice how you cope yourself as a parent. Model emotional language, and actively engage in coping strategies yourself. Make time for yoga, mindfulness, meditation, music, exercise, or whatever helps you feel calm and grounded. Take time for yourself. Don’t be afraid to implement family activities that are geared towards relaxation, such as an evening walk, exercising together, or working on an activity together like a giant jigsaw puzzle. Identify your own emotions and those of your child. A time when your child is very elevated and restless with stress and anxiety may not be the best time to identify and discuss emotions. At that moment, guide your child to do something to relieve stress. 
2. The cozy corner: You may want to have a cozy corner in your house that is filled with sensory objects your child enjoys. A swing or cozy chair, soft blanket, aromatherapy, music or calming sounds, pleasing photos, and fidget toys, are all good additions to the cozy corner. Show your child how simply sitting in a cozy place and focusing on pleasant objects can bring their anxiety down.
3. Get prepared: When it comes to stressful situations like a test at school or performance for dance or a presentation in front of the class, label and describe what anxiety can feel like. Guide your child to be prepared by studying or practicing over the weeks before the stressful event rather than in a cramming sort of manner. Show your child that they can be the boss of their stress by being more prepared. 
4. Help your child make the connection between worry and not feeling well: Children who spend a lot of time worrying also spend a lot of time in the nurse’s office, missing activities, stressing before tests. It is our job as adults to help them make the connection. Utilizing a clever character called ‘the Worry Monster,’ the book From Worrier to Warrior is a good resource for parents to help their kids understand this connection [1]. Teach your child the biology of anxiety. Help your child understand what anxiety is and why it happens and how to cope with stress. A great book to help with this is Please Explain Anxiety to Me. [2]
5. With warmth and safety, do not let them avoid the stressor: As adults, it is hard to watch our kids struggle with fears or anxiety. First, ensure that your child is safe. If the adults and the experience are safe, it will be important to disallow your child from avoiding the activity. Do not let your child simply skip school, a test, a game, or an activity. When you allow your child to not participate due to somatization or anxiety, they will feel better for a short amount of time. The next time they experience that stressor, they will be even more afraid than last time because they know that they were unable to endure it the previous time. Now, they are more anxious and will become persistent in their desire to get out of this stressful event. It is easy to fall into this trap as a parent. Yes, listen and support your child but do not get into the pattern of letting your child skip out on anxiety-provoking activities that are healthy and important to them. 
6. Have your child come up with solutions for the anxiety they are experiencing: Talk through the worry with your child and have them come up with their own solutions. This allows your child to feel in control.
7. Be light-hearted and silly: It is often true that ‘laughter is the best medicine.’ When your child is nervous, try not to join them in that experience. Instead, show that things are not such a big deal through your own light-hearted and jovial demeanor. They might not laugh right away, but they will appreciate that the stress level in the room has come down.
8. Stand up to worry: You might talk about the worry monster and how it has visited your child. Draw the worry monster and have your child talk back and say “no more.” Rip up the worry monster and throw it in the trash
9. Five deep breaths: After acknowledging the emotion, breathe through it. Feelings are like clouds. We let them come, and we let them go. Have your child place their hand on their belly and take five deep breaths in through their nose and out through the mouth
10. Visualize a favorite place: When your child is stuck on a worry, talking them out of it will generally not work. Instead, have your child close their eyes and ask them questions. Where are you? What do you smell, see, hear, feel? This experience can be silly if the child prefers that. Their favorite place can be a unicorn-filled land or a fairy garden. Imagine this calm place together. The somatosensory experience can change the child’s entire demeanor, reduce anxiety, and alleviate physical symptoms
11. Exercise: When we get worried, adrenaline is released into our bodies, and it generally takes about 72 hours to leave our systems. Exercise reduces this amount of time and can help your child feel safe and grounded sooner 
12. Put the worry in a balloon: Have your child put their worry in a balloon and imagine the balloon floating away, taking the worry with it. These visuals can be powerful metaphors that put the child back in control of their bodies and refocus their attention on a sense of safety and empowerment
13. Set up a worrying time: If your child seems to incessantly talk about worries, it can be a parent’s natural inclination to tune these worries out or simply suggest the child stop talking about them. Provide a time where the child can share their worries for a limited amount of time, 10-20 minutes. Let this be an uninterrupted time. Listen empathically with patience. Look at the facts and remind your child you are both strong enough for anything that comes your way in life. Use a worry box in-between worry sessions, where your child can write down their worry and put it away until worry time. Set up this time at least 2 hours before bedtime. 
14. Best case, worst case, most likely outcome: When we worry, we tend to think of the worst thing that could happen. Help your child map the worst thing that could happen, the best thing that could happen, and the most likely thing that will happen. It is important for us to remind ourselves and our children that most of the things we worry about never come to fruition. Generally, the most likely outcome is something that can be tolerated. If the child understands this, anxiety can go down significantly. 
15. Critical to compassionate self-talk: How we speak to ourselves affects how we feel. For example, if your child says, “I am going to fail this test, I will never understand, I won’t get into….” These thoughts increase our anxiety, causing us to feel awful. Our bodies do not know the difference between real danger and perceived danger. Help your child speak kindly and gently to oneself, just as they do for a friend. Model your own mindful self-compassion. 

When to Seek Help for Somatization in Childhood 

If these symptoms are too much to manage at home, involve the school psychologist, who may be able to do classroom-based anxiety interventions or spend time with your child individually. 

See whether learning concerns are present at school, as these concerns could be impacting anxiety. If learning concerns are present, actively seek support for them, as this support should help ease anxiety.

Seek out a private psychologist or counselor to work with your child on emotion regulation and coping skills. 

Finally, if symptoms continue to be severe, consider meeting with a child psychiatrist or pediatrician to discuss medication options and the associated benefits and drawbacks. Some homeopathic or naturopathic doctors can also be excellent sources of support for an anxious child.

Professional Resources for Somatization in Childhood

If your child is struggling with this symptom to the point that it is getting in the way of their learning, relationships, or happiness, the following professionals could help.

• Psychotherapist or play therapist: to treat anxiety and somatization symptoms and depression or any other emotional concerns; for a small child 6 and under play-based therapy may be a good fit. Those 7 and up are more likely to benefit from cognitive behavioral therapy focused on increasing emotional awareness and coping strategies
• School psychologist: to treat anxiety in the school setting; to make accommodations for testing with the teacher and team; to address learning concerns; to look at ways to adjust the setting to lessen anxiety; to meet with your child or a group of children
• Psychologist or neuropsychologist: to consider a full assessment to look at symptoms in mental health context and get a profile of your child’s strengths and weaknesses as well as recommendations for next steps
• Psychiatrist or pediatrician: to rule out medical cause, allergies or conditions like IBS that are impacted by stress and worry but also have medical cause; to share concerns about anxiety and learn about medical treatments that may be applicable

Similar Conditions to Somatization in Childhood 

• Intelligence: somatization may be related to giftedness. An individual with an IQ in the top 5% of the population; may be more sensitive and may have performance anxiety
• General anxiety: somatization could be related to general feelings of anxiety. These feelings occur in many contexts, not necessarily just with performance, socializing, tests, etc.
• Learning challenges: somatization could be due to learning challenges. Your child may be nervous before tests because of a cognitive processing or learning challenge related to a learning disability. When school is harder than it should be for your child, it can be anxiety producing
• Social skills challenges: somatization may be related to anxiety from social skill deficits, such as trouble reading other people. Sickness around test time may be more to do with the social judgment

Book References for Somatization in Childhood 

[1] Peters, Daniel B. (2013). From worrier to warrior: A guide to conquering your fears. 

[2] Zelinger, Laurie & Zelinger, Jordan (2014). Please explain anxiety to me. 

Resources on somatization and anxiety for kids 

Peters, Daniel (February 10, 2014). 10 steps for parents and kids to tame the worry monster. Huffpost Parents. 

Foxman, Paul (2004). The worried child: Recognizing anxiety in children and helping them heal.

Bender, Janet M. (2004) Tyler Tames The Testing Tiger. (For kids with test anxiety).

Helsley, Donalisa (2012). The worry glasses: Overcoming anxiety. 

Cook, Julia (2012). Wilma jean and the worry machine. 

Cook, Julia (2012) Wilma jean and the worry machine: Activity and idea book. 

Culbert, Timothy &  Kajander, Rebecca (2007). Be the boss of your stress (Be the boss of your body®). 

Meiners, Cheri J. (2003). When I feel afraid (Learning to get along).

Green, Andi (2011). Don’t feed the worrybug.