Somatic Symptoms and Children’s Emotions

Jul 15, 2008

Children will often complain of aches and pains, and it is difficult to know if there is cause for concern. Unfortunately, parents usually try to assess the medical issues and make a decision based on a physical spectrum. However, children dealing with emotional and behavioral issues will complain of the same things, but are often ignored.

Somatic symptoms are physical symptoms that occur within the body. Some common examples are headaches, stomach aches, gastrointestinal discomfort, lack of appetite, insomnia, etc. However, if these issues do not have a biological root in children, these can be labeled “psychosomatic”, or “relating to a disorder having physical symptoms but originating from mental or emotional causes” ( In other words, children will often have presenting symptoms that could be explained away by physical illness, but in reality they are dealing with the effects of emotional turmoil.

The majority of the children that I see have physical complaints that are medically unfounded. The easiest explanation is the simplest. Children do not have the verbal ability to express their feelings and emotions until 11 or 12 years of age. Therefore, when they feel the effects of an emotion internally and cannot identify it, it seems like a physical issue to them and that is how it is expressed.

Children who are depressed will often lose appetites, be lethargic, complain of headaches or stomach aches or want to sleep more than usual. Children who are angry will blow up and will be uncontrollable in a fit of rage. Children who are scared or anxious may get stomach aches or lose control of their bladder/bowels.

As adults, when we feel “butterflies in our stomachs”, we know what that sensation means. We can make sense of it. We recognize it, label it as anxiety, and try to work through it. To a child, it is different and uncomfortable and feels similar to a stomach ache from the flu. Therefore, any time a child feels nervous, “my tummy hurts” is a valid response.

So, how can we help our children to understand what these feelings are and know when it is a psychosomatic issue? Pay attention to other cues from the child. Do the complaints happen consistently in certain environments or surrounding specific events (school, visitation with another parent, daycare, etc.)? Also, can you notice a tone of voice or facial expression change associated with the complaint (anger, fear, sadness, etc.)?

By learning to read and respond to your child’s emotions, you will help the child feel understood, potentially alleviating the issue of physical complaints. Also, by telling the child what feeling you think he or she is feeling, you are helping to build the child’s emotional vocabulary. So, when a child feels scared and you tell him so, he learns the “butterflies” = “scared” and can then tell you that in the future.

It is a learning and growing process for both you and your child as you all are able to pinpoint more accurately the difference between physical and emotional pains. Please refer to my Reflecting Feelings article for examples of how to help accomplish this!

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