My child has been complaining of tummy aches. What could be the trouble?

Constipation and anxiety are the top two causes of stomach pain in children. Other common causes are irritable bowel syndrome (IBS), reflux and lactose intolerance. Most aren’t dangerous, but some might require treatment. Try to find out more by asking your child a few questions:

• Where does it hurt?
• When was the last time you pooped?
• What have you eaten?
• Are you worried about school, or anything else?
• What else is going on?

I suspect that constipation is the problem. How can I help?

If your child goes more than two days between bowel movements, or if pooping is hard or painful — even when regular — you’re probably right. Increasing the fruits, vegetables and fluids in your child’s diet will help. Being more active helps, too — walking and playing move the large muscles that help keep things moving inside. And make sure your child takes time to go, without rushing it.

If these measures aren’t enough, Miralax, a stool softener, is OK for kids. Start with 1 teaspoon and work your way up to the full dose, if needed, until things resolve.

Can anxiety about school cause real stomach pain?

Yes — the nerves in the gut have a direct line to the brain. When the brain detects anxiety, it may stimulate these nerves, causing vague but very real pain in the upper part of the tummy. Pediatricians often see anxiety-related tummy troubles at the beginning of a new school year.

Parents can help by reassuring children that it’s not harmful — it’s just their tummy’s way of telling them that they’re nervous about school. Deep breathing and soothing distractions can help, but kids should not be kept home from school — getting behind in school work can cause continuing anxiety and pain. If anxiety is severe, a pediatrician or psychiatrist can help.

I’m worried. Should I bring my child to the doctor?

Your child should see a doctor if stomach pain is accompanied by other symptoms, such as:

• Persistent Diarrhea
• Blood in the stool
• Weight loss
• Fever
• Vomiting
• Pain on the right side*
• Trouble walking*

*If either of these last two symptoms occurs, treat it like an emergency.

In addition, any time you’re worried or unsure what to do, call your pediatrician. We’re here to help keep your child healthy and safe.

Dr. Ulmer is the chair of the pediatrics department in our Beaverton office.