When Anxiety Causes Abdominal Pain in Children

Intro

Abdominal pain linked to anxiety — often called functional abdominal pain — is one of the most common causes of recurrent pain in children.

It can be intense, frightening, and disruptive.
And crucially:

The pain is real, even when tests are normal.

Understanding the pattern of anxiety-related pain helps families support children confidently without missing serious illness.

Why Anxiety Can Cause Real Pain

The gut and brain are tightly connected through the gut–brain axis.

In children:

Stress increases gut sensitivity
Normal bowel movements can feel painful
Gut motility may speed up or slow down
Pain signals are amplified

There is no tissue damage, but the pain experience is genuine.

Common features include:

Pain around the belly button
Recurrent episodes over weeks or months
Pain before:
- school
- exams
- social events
- separation from caregivers
Improvement on weekends or holidays
Normal appetite and energy between episodes
Normal physical exams and tests

Behavioural Clues That Reassure

Often more useful than pain descriptions:

Observation	Suggests
Distractible pain	Functional
Plays when engaged	Low risk
Pain settles with reassurance	Functional
Normal growth	Reassuring
Stable pattern	Functional

What Anxiety Pain Is Not

Anxiety-related pain usually does not:

Progressively worsen over hours
Localise to one spot
Wake a child from sleep
Cause persistent vomiting
Stop a child from walking or moving
Cause weight loss or poor growth

If these occur, reassessment is needed.

Supporting a Child Safely

Key principles:

Validate the pain — don’t dismiss it
Avoid excessive testing once serious causes are excluded
Maintain routines and school attendance when safe
Avoid reinforcing avoidance or sick-role behaviours
Address underlying stressors gradually

Psychological strategies (e.g. CBT) can be very effective when needed.

When to Re-evaluate

Seek medical review if:

Pain pattern changes
Pain worsens or localises
Pain wakes the child from sleep
Vomiting, fever, or blood in stool appears
Appetite or growth declines
Movement becomes painful

Anxiety vs Appendicitis vs Constipation (quick contrast)

Feature	Anxiety-related	Appendicitis	Constipation
Time course	Recurrent, stable	Progressive	Chronic/recurrent
Localisation	Central	Often right-sided	Diffuse/lower
Movement pain	No	Yes	Usually mild
Appetite	Usually normal	Drops off	Variable
Response to reassurance	Improves	No	Sometimes

Decision Pathway

flowchart TD A[Child with abdominal pain] --> B{Progressive or localising pain?} B -->|Yes| C[Medical reassessment] B -->|No| D{Red flags present?\nVomiting, fever, night waking,\nmovement pain, weight loss} D -->|Yes| C D -->|No| E{Predictable stress-related pattern?} E -->|Yes| F[Likely anxiety-related\nSupport + routines + monitor] E -->|No| G[Consider other causes\nConstipation / UTI / review]

FAQ

Q: Can anxiety really cause severe pain?
A: Yes. The pain experience is real, even without disease.

Q: Will this cause long-term damage?
A: No. Functional abdominal pain does not damage organs.

Q: Should school be avoided?
A: Usually no. Maintaining routines helps recovery unless red flags are present.