After Jake Smith complained about stomach pain, his mother took him to a gastrointestinal specialist. Tests, which included an endoscopy to inspect the boy’s stomach and digestive tract, showed no problems.
But for Jake, the pain was unrelenting.
The doctor referred Jake to a pediatric psychologist on the chance that anxiety was causing severe cramps and literally making the boy — 6-years-old at the time — sick to his stomach.
Anxiety over the uncertainties of going back to school or participating in sports or other extracurricular activities is hitting young people in the gut. Children’s Health in Dallas is currently seeing an increase in patients with stomach issues, including chronic diarrhea and constipation, caused by high levels of anxiety.
And experts say that as parents weigh whether to send their children back to school or get involved in sports, they should consider the emotional health of the child as well as the physical risks.
Some children will get “very, very stressed out” at the prospect of going back to school and attending in-person classes “because the anxiety of ‘Oh, I’m going to get COVID and die,’ is just so pervasive,” said Dr. Rini Sanghavi, a pediatric gastroenterologist at Children’s Health.
The anxiety-induced, or psychosomatic, pain, can take the form of headaches, as well as abdominal or lower back distress. In extreme cases, the pain causes havoc in the lives of those affected. Some are elite athletes, who can’t go back to their sport or dance. And some even become wheelchair-bound because the pain is so crippling.
Stomach problems are a common symptom of stress and anxiety. Everybody at some point feels “butterflies in the stomach,” but severe anxiety can cause debilitating pain that limits mobility.
“We’re seeing it everyday, especially with COVID with all the uncertainties,” said Kimberly Williams, a clinical social worker and behavioral healthcare manager at Children’s Health Andrews Institute for Orthopedics & Sports Medicine in Plano.
“The pandemic is turning their lives upside down,” Williams said.
The pain is not a figment of the imagination. “The pain is real. The psychological part is understanding what’s triggering the pain,” Sanghavi said.
Jake knows the feelings all too well.
About 10 years ago, beginning in first grade, he developed a terrible, debilitating fear of storms. He also became afraid of contagious illnesses. For example, any time he heard something on the news about salmonella, a bacterial infection of the intestine, he would get severe cramps in his stomach.
But the fear escalated to the point where he wouldn’t touch a stick because a lizard might have walked across it and left germs on it, said his mother, Lisa Smith, of Dallas.
Sometimes Jake would tell his mom that his heart was beating too fast. “And I would touch it and say, ‘No you’re fine,’ “ Lisa said.
The Smiths eventually took Jake to see a gastroenterologist at Children’s, who performed a series of tests. The specialist found nothing wrong with Jake’s digestive system.
“But his anxiety is settling in his stomach,” Lisa recalled the doctor telling her.
He referred the family to a child psychologist affiliated with Children’s. That’s when Jake started getting better.
The psychologist and one of her students worked with Jake to create a booklet of actions he could take if he felt anxious. The black book became his toolkit.
When the weather turned stormy, Jake said he would go to a section of the book he had created with his psychologist called “Brave Thoughts About Weather.” That section included a half-dozen or so pages of ideas about things he could do or think about “to keep my mind off the storm,” he said.
“There’s one that says, ‘Even though the weather is bad right now, it will clear up soon,’ “ he said.
Learning to shift away from obsessive thoughts that trigger a cycle of anxiety is one of the key treatments for people, like Jake, who was diagnosed with obsessive-compulsive disorder, or OCD.
People with OCD suffer from a “constant static noise in the brain,” said Sanghavi, who did not treat Jake, but has seen many other young patients, like Jake, at her gastrointestinal practice.
That noise can be any intrusive thought that repeats itself, Sanghavi said.
Stressful thoughts like these send danger signals to the brain and stimulate the flight-or-fight response, causing the gut to cramp up. These spasms are what cause stomach pain, including constipation, diarrhea or nausea.
“That’s really the basis of these stomach issues when you’re anxious,” Sanghavi said.
It’s fairly common for anxiety to cause chronic abdominal pain, with as many as one-fourth of the population — adults and children — suffering such symptoms to varying degrees, she said.
Children’s Chronic Abdominal Pain Clinic sees nearly 100 new patients a year, who are all less than 18 years old, and the majority of these patients have anxiety-related stomach issues.
Treatment includes a combination of medicine and physical therapy, if needed, along with psychological counseling and lifestyle changes, particularly with diet and sleep habits.
The pandemic is causing rampant anxiety, not just among children but also their parents, who struggle with the dilemma of whether to send their children to school.
To help with this decision, Children’s Health and UT Southwestern published a guide for parents of risk categories based on experts’ consensus. High-risk medical conditions include asthma, cystic fibrosis and muscular dystrophy.
But parents also need to take into consideration their child’s emotional health, Sanghavi said, and that includes children who don’t do well limiting school to online classes only.
“And those children — if everything else is safe — would need to be in an in-person school setting with their friends,” she said.
Her own two pre-teen children wanted very much to go back to school, and she felt it was important to include their preference in the decision along with knowing the safety protocols the school was taking.
“They felt very strongly that emotionally they needed to be back at school,” Sanghavi said. “So I supported them.”
In the last year, Jake’s worst fears about weather and disease came true. In October 2019, a severe tornado crashed through his neighborhood. And this spring saw the country shut down because of a global pandemic.
But now, unlike 10 years ago, Jake had tools to use.
When the tornado swept across his northwest Dallas neighborhood, Jake knew from a plan the family had developed to sit in a protected hallway inside the house. Though his anxiety rose, he also knew to tell himself that the storm would soon pass. And he knew how to do deep-breathing exercises to stay calm.
Less than five months later, the coronavirus pandemic hit home, causing schools to shut down.
At first, he didn’t want to look at the news. But when the schools shut down, his mother told him there was no way they could completely ignore the pandemic. They had to keep track of what was going on.
To keep his thoughts about the virus from running away to worst-case scenarios, Jake put his mind to work researching what was known about the pandemic.
“I looked at the facts and the ratios of people who recovered,” he said.
He continues to keep track of the virus. “He knows the days the cases are up and he knows when the cases are down,” said Lisa, his mom.
But he doesn’t obsess over the news, his mother said. She doesn’t monitor how much news about the pandemic he consumes, because “he’s doing a good job of being in control,” she said.
She thinks back to how this past year would have affected Jake 10 years ago.
“I can see how if we were in the same situation when he was 7, he would’ve been completely off-the-charts obsessed with all of this,” she said.
“It has been a struggle, but he has stayed on top and I am so proud of him,” said his mom.
Jake said he would tell fellow students anxious about returning to school to learn some tools about managing that anxiety.
One simple, but effective, tool is to do breathing exercises, he said.
“Breathe in through your nose and out through your mouth to calm down, and let your body relax,” he said.
“Don’t think about the pain in your stomach,” he said.
“I would close my eyes and think about a place that makes you happy.
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