Does a Tummy Ache Indicate Heart Ache?

Stomach aches in children linked to anxiety and depression over long term

(RxWiki News) A tummy ache is one of the classic childhood complaints that lands children in the school nurse's office. But the real source of the pain may be somewhere else.

A recent study found that children with long-term abdominal pain, explained or not, were more likely to have anxiety at some point in their lives.

Often, the anxiety occurred before the child experienced stomach problems.

Children with persistent stomach aches were also more likely to develop depression at some point.

"Talk to a pediatrician about your child's persistent tummy aches."

This study, led by Grace D. Shelby, PhD, of the Department of Psychology and Human Development at Vanderbilt University, looked at children's abdominal pain and their anxiety.

The researchers followed 479 children, starting between the ages of 8 and 17, for a minimum of four years.

Of the children followed, 332 of the children had abdominal pain that lasted for at least three months. Meanwhile, 147 of the children did not have abdominal pain and were used as comparisons because they came from the same schools as the children who did.

All the children were evaluated for psychiatric disorders and any gastrointestinal disorders during follow-up periods when they were teens and young adults.

The researchers found that about half of the children with abdominal pain (51 percent) had an anxiety disorder at some point during their lives. Thirty percent of them had an anxiety disorder at the time they were evaluated in follow-up.

Meanwhile, only 20 percent of the comparison children without abdominal pain had an anxiety disorder at any time in their lives, and 12 percent had an anxiety disorder during follow-up evaluation.

The researchers calculated that having abdominal pain made it five times more likely that a child would have an anxiety disorder at some point in their young lives than if they didn't have abdominal pain.

The participants with abdominal pain were 3.5 times more likely to have an anxiety disorder during follow-up evaluation than participants without it.

In general, the children were more likely to have had an anxiety disorder before they were evaluated for their stomach pains.

Yet the children who had depression were more likely to develop it after seeing a doctor for their abdominal troubles.

In fact, 40 percent of the children with abdominal pain had diagnosed depression at some point in their young lives, compared to 16 percent of the children without abdominal pain.

There was no difference between the children with and without abdominal pain in terms of whether they had depression at the time they were evaluated.

Anxiety appeared to be linked to having an actual gastrointestinal disorder as well.

Among the children with abdominal pain who tested positive for having a specific gastrointestinal disorder, 40 percent had an anxiety disorder.

Among the children with abdominal pain who did not appear to have any specific gastrointestinal disorder, 24 percent had an anxiety disorder.

"Patients with functional abdominal pain carry long-term vulnerability to anxiety that begins in childhood and persists into late adolescence and early adulthood, even if abdominal pain resolves," the authors concluded.

The findings were not surprising to Dr. Seman, MD, a pediatrician at North Shore Pediatrics in Danvers, Mass.

"Abdominal pain is a very common issue in children with many diverse causes," he said. "That said, many times it is related to emotional issues."

Dr. Seman said the stomach is often referred to as a "second brain" because the system is controlled by a set of connected clusters of nerves that use similar types of communication chemicals, called neurotransmitters, as the brain.

"When the brain and child gets stressed the stomach can get stressed," he said. "Those 'butterflies in the stomach' when nervous or sad can often morph into stinging hornets causing pain, cramping, diarrhea and nausea."

Dr. Seman said he has seen this in about 30 to 50 percent of the children who come in with intermittent abdominal pain.

"Exacerbations will frequently come during stressful times, such as the beginning or end of school, a birth or death in the family or other such transitions," Dr. Seman said. "When they are unable to cope completely, they develop symptoms such as headache, fatigue and stomach aches, to name a few."

The key to successful treatment, Dr. Seman said, is open and honest communication.

"Parents and children being completely honest with their pediatrician is important in all cases, but more so when trying to decipher such common complaints," he said.

This study was published August 12 in the journal Pediatrics. The authors declared no conflicts of interest.

The research was funded by the National Institute on Child Health and Development, the Vanderbilt Kennedy Center, Vanderbilt Digestive Disease Research Center, Vanderbilt CTSA, the National Institutes of Mental Health and the National Institutes of Health.

Review Date: 
August 13, 2013