Children’s health: How anxiety can affect your child’s stomach

If your child often complains of a stomachache before school, a big game or a test, it may not just be “nerves.” Experts say there is a strong connection between a child’s gut and their brain — and it can play a big role in both physical and emotional health.

“The gut and the brain are constantly communicating,” said Lauren Potthoff, PhD, a pediatric psychologist at Lurie Children’s. “When a child feels anxious, that stress can show up in the body, especially in the digestive system.”

This connection, known as the gut-brain axis, helps explain why anxiety and stomach issues often go hand in hand.

A two-way street between brain and body

The digestive system has its own network of nerves, sometimes called the “second brain.” Because of this, emotional stress can directly affect how the gut works.

When a child feels anxious, the body goes into “fight or flight” mode. Stress hormones like cortisol and adrenaline are released, which can speed up digestion. This may lead to symptoms such as stomach pain, cramping, nausea or even diarrhea.

“It’s a very real physical response,” Dr. Potthoff said. “Kids aren’t making it up. Their bodies are reacting to stress in a way that affects how their gut functions.”

For many families, the pattern becomes clear over time. Symptoms may appear before school, social events or performances, then ease once the stressful situation passes.

How stress affects digestion

Stress doesn’t just cause short-term discomfort. Over time, it can affect the digestive system in several ways.

Chronic stress can change how food moves through the gut, leading to constipation, diarrhea or bloating. It can also disrupt the balance of bacteria in the gut, known as the microbiome, which plays a key role in digestion and overall health.

In addition, stress can make the gut more sensitive. This means children may feel pain more intensely, even if there isn’t a clear physical problem.

“Sometimes the gut becomes more reactive,” Dr. Potthoff explained. “Things that might not bother another child can feel very uncomfortable for a child dealing with ongoing stress or anxiety.”

When it could be something more

While occasional stomachaches are common, frequent or ongoing symptoms may point to a condition such as irritable bowel syndrome (IBS), a common digestive disorder in children.

IBS can cause crampy abdominal pain, along with diarrhea, constipation or both. It is often described as a “disorder of brain-gut interaction,” meaning symptoms are linked to how the brain and gut communicate.

“Stress and anxiety are major triggers for IBS symptoms,” Dr. Potthoff said. “Many kids notice their symptoms get worse during stressful times, like exams or big life changes.”

Other factors, such as food sensitivities or a recent stomach illness, can also play a role.

Parents should talk with their child’s doctor if symptoms last for several months, worsen over time or interfere with daily activities.

What parents can do

The good news is there are ways to help children manage both anxiety and digestive symptoms.

Experts recommend starting with simple strategies that support both the mind and body.

Teaching relaxation techniques can be especially helpful. Deep breathing exercises, such as slow “belly breathing,” can calm the nervous system and ease stomach discomfort.

“Helping kids learn how to slow down their breathing can make a big difference,” Dr. Potthoff said. “It gives them a tool they can use anywhere.”

Creating predictable daily routines can also help. Regular mealtimes, consistent sleep schedules and a calm morning routine can reduce stress and support healthy digestion.

Physical activity is another key piece. Exercise helps reduce anxiety and keeps the digestive system moving. This doesn’t have to mean organized sports — simple activities like walking, biking or playing outside can be effective.

Parents may also want to track foods and symptoms to identify possible triggers. Some children find that certain foods worsen their symptoms, though triggers vary from child to child.

Addressing anxiety directly

Because stomach issues are often linked to emotional stress, it’s important to address anxiety itself.

Open, supportive conversations can help children feel safe sharing their worries. In some cases, working with a mental health professional may be beneficial.

“If anxiety is impacting a child’s daily life, it’s important to get support,” Dr. Potthoff said. “Treating the anxiety can often improve the physical symptoms as well.”

A whole-child approach

Ultimately, experts emphasize that gut health and mental health are closely connected, and both deserve attention.

By recognizing the signs, understanding the gut-brain connection and working with health care providers, families can help children feel better physically and emotionally.

“Looking at the whole child is key,” Dr. Potthoff said. “When we support both their emotional well-being and their physical health, we can make a real difference.”

• Children's health is a continuing series. This column was provided by Ann & Robert H. Lurie Children's Hospital of Chicago.