He Says His Stomach Hurts Only at School

"They are fine at home. But the moment they get to school, they say their stomach hurts."

This is what I hear most often from parents who bring in middle school and high school students. The child comes home early because of stomach pain, and once home is fine as if nothing had happened. The child says the chest feels tight at school and that breathing does not come easily, and when tests are done, neither the heart nor the lungs show anything wrong.

Then the parent asks carefully. Is my child making it up?

I tell them no. And I explain why not.

The body does not react after the event

If our body waited until danger had arrived to begin responding, it would be too late. So the autonomic nervous system reads a situation that looks likely to happen and prepares first.

This is nothing special. Sweating palms before a presentation, a stirring in the stomach before the exam paper is handed out, a dry mouth before walking into an interview room — these are all the same thing. Nothing has happened yet, and the body has already changed.

The child is not producing this response. Nor is it something the child can stop. It is like not being able to stop your palms from sweating by will.

A state of readiness does not touch only one place

This is the important part. When the body goes into a state of readiness, it is not one thing that changes. Several places are adjusted at the same time.

The stomach slows down. It is because the body judges that now is not the time to spend effort on digestion. What has been eaten stays in the stomach as it is, so the area below the breastbone feels tight and heavy.

Yet the large intestine goes the other way and becomes hurried. Receiving the same signal, the stomach and the large intestine move in different directions. That is how the combination of a hurting stomach and an urgent need for the bathroom comes about. From the upper elementary years on I often hear that the child keeps going in and out of the bathroom, and this is where that belongs.

The breath becomes shallow and fast. When tense, it happens on its own. But breathing out more than needed lowers the carbon dioxide in the blood, and when carbon dioxide falls, the blood flow to the brain decreases instead. So there is dizziness, a foggy head, and tingling fingertips. This is where the thing that looks contradictory arises — breathing more and feeling more short of breath.

That the stomach and the breath come together in one child is not a coincidence. It is the result of one state of readiness moving several places together.

So it depends on the place

Being fine at home is not the strange part; it is rather the part that makes sense.

The body does not switch on a state of readiness just anywhere. It switches it on only in a situation it has read as needing that state. Home is not that situation and school is. So it lets go when the child gets home.

That the same body works differently depending on the place is not evidence of a made-up illness; it is evidence that the autonomic nervous system is reading the situation. I make a point of telling parents this part. It is also the point the child feels most wronged about.

Why it is so common at this age

Adolescence is a time when the body's regulating systems are being reset in earnest. While height increases and the body's volume changes, the regulation that matches blood pressure, heart rate, and the pace of digestion is also newly adjusted along with it. A scale that is being adjusted swings more widely under the same weight.

On top of this come conditions of not enough sleep, irregular meal times, and a sitting posture that stiffens. It amounts to conditions for swaying arriving together in a period that sways easily.

What I do in the clinic

If it were something that could be settled by steeling oneself, the child would have done so already.

So I go toward changing the conditions. If the speed at which the stomach empties is lagging, I help that side; if the side where the bowel becomes hurried stands out, I soften that side. For a child whose breath is shallow, rather than telling them to breathe deeply, I show them how to lengthen the breathing out. Increasing the breathing in lowers carbon dioxide further instead.

Which part is swaying more widely differs from child to child. So even when they come in with the same story, I use a different medicine for each child.

When to see a doctor first

If weight is clearly dropping, if the child wakes at night from pain, if there is blood in the stool, if a fever comes along with it, or if the place the stomach hurts has settled into one spot — pediatric care comes before this story. The same goes for when the tightness of breath becomes especially bad during exercise.

This piece is about how to look at what comes next when the tests have not turned up anything in particular.

Parents tell me that the hardest part when a child says they are hurting is the moment you do not know whether to believe that they are hurting. You may believe it. The child really is hurting. It is only that the hurting place is not a place that shows on a test.

If the tightness of breath is the more prominent side, you may also read If breathing feels short but the tests are normal; if the belly grows taut and the chest feels tight along with it, you may read If a full belly brings chest tightness and palpitations.

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Sources

• A review summarizing that stress delays gastric emptying while raising large-intestinal motility in the opposite direction — Journal of Clinical Investigation, 2007
• A study measuring in humans the degree to which cerebral blood flow decreases along with falling carbon dioxide in the blood — The Journal of Physiology, 2011

Written by Dr. Heo Ji-young (Ph.D. in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)