Your child has a stomachache that just won’t go away. He doesn’t want to go to school. He may even have physical symptoms such as fatigue, vomiting and diarrhea. But is the cause of his pain a medical condition?

“Unless the symptoms have been present for four months or longer, and there is significant weight loss and/or blood in the vomit or stool, there is a less than a 1 percent chance that there is something medically wrong with the child,” said Jeffrey Fahl, MD, a pediatric gastroenterologist at Seattle Children’s Hospital.

Believe it or not, the cause of the pain and symptoms is most likely a combination of gastrointestinal issues and psychosocial stressors, said Carin Cunningham, PhD, an attending clinical psychologist for Psychiatry and Behavioral Medicine at Seattle Children’s.

“It’s often difficult for parents to understand that the physical and the psychological factors are woven together,” said Cunningham, who specializes in treating kids with gastrointestinal diseases. “Parents see the discomfort and know their children are in pain, so they think that there is a medical diagnosis that has not been identified. What they often don’t understand is that when the brain is ‘in pain’ it will send signals to other parts of the body, most often the stomach and the gut.”

Determining if the root cause is medical or psychosocial requires coordination between the medical teams, said Fahl.

“Once we’re sure it’s not something organic or inflammatory, or otherwise medically significant, it becomes a team effort to help the family understand why the child is experiencing pain, find ways to lessen the pain and get the child back to a normal life,” he said.

Determining the root cause

The first step for parents who fear their child’s stomachache may be serious is to schedule a visit with their pediatrician. The primary care doctor will almost always know whether to refer the child to a specialist, said Fahl. If a visit to a specialist is needed, a blood test can confirm or rule out most major medical conditions.

“We look for a drop in their red blood cell count, increased inflammatory markers and celiac disease,” a genetic disorder that is triggered by gluten and causes an autoimmune reaction. “If all of those tests are negative, the likelihood of a significant medical condition is very low,” Fahl said.

That’s when Cunningham is consulted. She screens for life stressors such as a new baby in the family, divorce, death, a move or change of school, or the possibility that the child is being bullied. Other clues that Cunningham watches for include whether or not the child has always been a worrier, or if there are other worriers in the family.

“We want parents to compare the child to who they used to be before they felt sick and focus on improvement of the child’s functioning,” said Cunningham.

Getting back to normal

If there is no reason to believe a medical condition exists, and there are stressors present that could be manifesting in stomach pain or other symptoms, Cunningham prescribes important actions for both the child and the parents.

“For the child, it’s important to exercise, eat right, practice breathing techniques and other stress-reducing activities, including yoga,” she said. “Sleep also is a critical issue. Recent studies have shown that with improvement in sleep patterns, pain decreases.”

“It’s incredibly important to acknowledge the child’s pain,” Cunningham said, “but also make it clear to them that they need to get on with life.”

The child needs to go to school, play with friends and continue with the activities that she loves.

“Staying out of school becomes a huge problem because the longer the child is gone, the harder it is for them to go back,” she said. “They worry that other children will ask what is wrong with them and why they’ve been gone.”

But probably the most important tip for any parent or caregiver, Cunningham said, is that parents “need to make sure they are taking care of themselves.”

“Kids feel what parents feel,” she said. “Take care of yourself and you’ll teach your child how to do the same.”

Have questions or need additional information? Talk to your child’s doctor or another primary care provider.