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Back-to-School Stress

November 15, 2019

Returning to school may cause anxiety that leads to stomachaches

When the carefree days of summer come to an end and it’s time to return to school, some children may develop stomach pain. It’s important to know whether it’s something serious or just back-to-school jitters.

“We know that 25% of school-age children will complain of recurring belly pain,” says pediatric gastroenterologist Joel Rosh, MD. “There are five abdominal symptoms, including stomach pain, nausea, vomiting, diarrhea and constipation.”

Organic and Functional Causes of Stomach Pain

Dr. Rosh says there are two primary causes of stomach pain: organic and functional. Examples of organic pain include tissue injury, abnormal anatomy or ulcers. “An important contributor to functional pain can be stress, worrying or anxiety,” says Dr. Rosh. “The brain runs your body and controls what happens in your stomach. Then the stomach talks back to the brain and tells you what is going on.”

Dr. Rosh’s program performed a study that looked at medication for abdominal pain versus a placebo, or a substance that is made to look like a real drug. “It turned out there was no difference,” says Dr. Rosh. “The reason is that we first gave an hour of education to every family to explain why the belly hurts, and 88% got better with just the education.”

For children who may be suffering from something more, parents should look for the following red flags: weight loss, throwing up in the middle of the night, passing blood, and symptoms outside the GI tract such as fevers or rashes. Conditions that pediatric gastroenterologists look for include celiac disease and inflammatory bowel disease such as Crohn’s disease. “If there are no red flags and a physical exam is normal then the cause of the belly pain is likely functional,” says Dr. Rosh.

If a child is suffering from anxiety-related stomach pain, Dr. Rosh says relaxation techniques such as mindfulness can be helpful. “Outside the brain, the stomach has the most nerve tissue in the body, and you can activate those nerves just by thinking; so it is like an internal thermometer. Is the child getting enough sleep, or is he or she eating right? If the stomach is hurting, it just signaled that something isn’t optimized today.”

Dr. Joel Rosh and the pediatric gastroenterology team are part of Atlantic Medical Group, a multispecialty network of health care providers. For more information, visit or call 973-971-5676.