© 2012 Roy Benaroch, MD
Dave’s story: “I have a six year old who gets a lot of belly aches. She’s seen her ped and a GI, and all the tests say nothing. Her belly aches really only happen in the morning before school. I think it might be psychological, and have told her about the boy who cries wolf, but she insists that her tummy hurts. What should we do?”
We need to settle one thing up front. These belly aches are in every sense “real”, even if they’re related to psychological factors on school days. The pain is real, because the pain hurts. Telling her that it doesn’t hurt, or talking with her about boys and wolves, is unlikely to help her feel better.
There’s this weird, false dichotomy in medicine between “real” and “not real” in the way we talk about medical problems—as if psychiatric or psychological issues are less important in some way. Sometimes words like “organic” are used for “real” pathology, as opposed to “inorganic”, whatever that means. You’ll also see references to “functional” pain, somehow implying that this kind of pain is somehow less real. But it still hurts!
There’s even a specific name for “GI pain where no pathology can be seen through a microscope and no lab tests are abnormal but nonetheless it hurts and ow I wish it would feel better.” It’s called irritable bowel syndrome, and it affects millions. Again: it hurts.
Dave’s already taken an important step: by keeping track of the symptoms, he’s narrowed this down to a school-morning phenomenon. That’s very important information, because it tells us that we don’t need more invasive tests or procedures. Instead, we ought to be focusing on ways to help the child feel better. Is there a specific stressor (like a bully) at school? Can we reduce overall stress in other ways? Can we think of ways to make school mornings a little less dread-inducing? Perhaps, in addition to reducing stress, we can also start to teach the child new ways of dealing with stress—like a special lovey to hug, or a punching bag to whale on (you can see, the approach may depend on the child!) Things like a hot water bottle, extra time on the toilet, or waking up early enough so the family doesn’t have to rush can all help.
The bottom line: belly aches that only happen on school day mornings are real. Parents won’t be able to talk their child out of it. Instead, we ought to be working with our children to see how we can help them feel better.