"I have a 7 year old daughter and for the past 2 years she complains of belly aches a lot and we don't know when she is really sick or just upset about something. I have learned to ask her questions and we usually get to the problem. My question is how can we get her to express how she feels and not make her stomach hurt? What can we do and should we involve our family doctor?" – Amanda

Dear Amanda,

It sounds like you are picking up an emotional side to your daughter's stomachaches. However, that does not mean there may not be a physical or medical basis for them, such as irritable bowel syndrome, to name a few.

Start by your daughter having a thorough exam with the pediatrician. Before attributing stomachaches to psychological issues, physical or medical causes must be ruled out. The pediatrician is most qualified to make that assessment. He or she may refer your daughter for further testing to a specialist, such as a gastroenterologist. But, only after a thorough medical examination of your daughter's stomachaches, should you then consult with a mental health professional for guidance regarding the emotional issues that may trigger or worsen stomach pain or spasms.

Also, keep in mind that physical and psychological disorders affecting the stomach can exist together and even interact. So, even if you do find a medical basis for your daughter's stomach pains, you may want guidance from a mental health professional to help your daughter as well as you, the parent, better understand and cope with the whole situation.

Common psychological conditions that trigger or may present with stomachaches are anxiety and depression. Anxiety disorders are surprisingly common in children and may be triggered by many different kinds of stress. Phobias, depression and any traumatic events may also present with various physical symptoms, including abdominal pain, that are very real in children, even if medical tests are normal.

Finally, be patient and seek help if your daughter won't talk to you about her feelings when she has a stomachache. She is very young to have much of an idea as to what is going on that may be upsetting to her, if a situation is triggering the pain. You may feel she is "faking" the tummy aches to get attention. But, as your frustration mounts, you may be making a false assumption and creating a greater rift between you and your daughter unless you have professional guidance.

Mental health professionals and some school psychologists who work with young children frequently see anxiety disorders. Not all situations require medication. Often a trained professional can help you and your daughter pinpoint the triggers for her aches and suggest behavioral strategies to help.

My advice is to first go to your family physician or pediatrician and keep your mind open to seeking a qualified therapist to help you, your daughter and the family to cope better with her behavior. Anxiety and depression are well recognized in children, and can be effectively treated with proper help.

Be patient as the process may take some time. Your daughter is really suffering and is not trying to be difficult.

Good luck! ~ Patricia Foster, M.D.