Psychosomatics
Psychosomatics in Children: When the Body Shows What the Mind Feels
What's behind stomach pain, headaches, and nausea without an organic finding - and why your child's body isn't making it up.
Monday, 7:15 AM. Your child is sitting at the breakfast table, complaining about stomach pain. Not for the first time. The pediatrician has run every test - blood work, ultrasound, stool sample. Everything unremarkable. Yet the pain is there. Real, measurable, distressing.
Psychosomatic complaints in children are not imaginary. They are the result of a concrete physiological mechanism that medicine increasingly understands. According to 2024 German rehabilitation statistics, psychosomatics is now the most common indication in pediatric rehabilitation - a trend reversal that shows how widespread the phenomenon has become.
What happens in the body
When your child experiences stress - whether from school anxiety, social conflicts, or overwhelm - the brain activates the HPA axis, the body's central stress system that releases the stress hormone cortisol via the hypothalamus, pituitary gland, and adrenal cortex. This system is essential for survival: it prepares the body for strain.
In children with psychosomatic complaints, this stress axis often remains permanently activated. The body continuously releases cortisol, even when there's no acute threat. The consequences are tangible: intestinal muscles cramp, stomach acid production changes, pain processing in the spinal cord becomes more sensitive.
Your child's stomach pain is not imaginary - it's the body's response to a chronically activated stress system.
The following conversations are taken directly from the app - uncut and unedited.
User question
Why does my child always have stomach pain before school?
Rehavio (Parents)
Stomach pain before school is often a sign that your child's body is reacting to stress.
When your child is nervous or anxious, the brain releases stress hormones. These hormones act directly on the gastrointestinal tract - where a particularly large number of nerve cells sit that respond to stress. The stomach produces more acid, intestinal movements change, sometimes the muscles cramp. These are real physical pains, not imaginary.
Your child is not faking it. The stomach pain is real, even when no organic condition is present. The mechanism is called somatoform disorder - meaning the body expresses emotional stress through physical symptoms.
What could be behind it? Performance pressure, social anxiety, conflicts with classmates or teachers. Sometimes also overwhelm from too many stimuli or unrecognized learning difficulties.
The stomach pain often disappears on weekends or during holidays - a clear sign of the connection to school. The important thing is to work together to find out what exactly is causing the stress. A conversation with the teacher can help identify possible triggers at school.
This response is from Rehavio. You can ask your own questions - about your situation.
The stress axis - why "just relax" doesn't work
A common impulse: telling the child to calm down. The problem: the HPA axis operates autonomously. It cannot be shut down by willpower. In children whose stress system is chronically activated, the cortisol baseline is higher than in other children. Their body exists in a state of permanent alert.
Interoception - the ability to perceive internal body signals - is often altered in these children. They feel their body's signals more intensely but struggle to categorize them. A slight stomach rumble is perceived as pain because the brain interprets it as a warning signal.
User question
What is the HPA stress axis?
Rehavio (Parents)
The HPA axis is your body's stress system. HPA stands for hypothalamus-pituitary-adrenal cortex - three areas that work together like an alarm chain.
When your child experiences stress (school anxiety, conflict, overwhelm), this chain starts:
The hypothalamus in the brain detects the danger and sends a signal to the pituitary gland. The pituitary gland is a small gland in the brain that produces hormones. It passes the command on to the adrenal cortex. The adrenal cortex sits on top of the kidneys and releases cortisol - the main stress hormone.
Cortisol prepares the body for fight or flight: blood sugar rises, the heart beats faster, digestion is slowed down. That's why your child gets stomach pain - the gut reacts very sensitively to cortisol.
With chronic stress (daily before school), the HPA axis remains permanently activated. Cortisol levels no longer properly decrease. This explains why the stomach pain can get worse over time.
The good news: the HPA axis can calm down again. Relaxation techniques, exercise, and resolving the source of stress help to bring the system back down.
Why "Is it all in their head?" is the wrong question
The question of whether psychosomatic complaints are "real" is based on a misunderstanding. Somatic markers - a concept by neuroscientist Antonio Damasio - demonstrate that emotional experiences are stored in the body. Fear of a test doesn't just create a feeling - it produces measurable changes in gut activity, heart rhythm, and muscle tension.
In children, the connection between emotional experience and physical reaction is particularly direct. The prefrontal cortex - responsible for cognitively processing emotions - is not yet fully developed in an 8-year-old. The child cannot rationally "think away" the stress. Instead, the body expresses what the brain cannot yet put into words.
User question
How can I help my child without dismissing what they feel?
Rehavio (Parents)
The balance between taking it seriously and not catastrophizing is hard - you're right to think about it.
First, validate the physical feeling: "I believe you that your stomach hurts. This isn't acting." Your child needs to feel that you acknowledge the pain as real. Sentences like "You're just imagining it" or "Stop overreacting" only increase the stress.
Name the mechanism in a child-friendly way: "Sometimes worry shows up in your stomach. Your stomach and your brain talk to each other - when your brain worries, your stomach speaks up." This helps your child understand the connection without feeling "crazy."
Focus on coping rather than avoidance: Not "Then you can stay home today," but "What would feel good for your stomach right now?" Hot water bottle, belly massage, breathing exercises - concrete help for real pain.
Detective work without interrogation: "What's happening at school tomorrow?" instead of "Why are you scared?" Open questions without pressure help find the source of stress.
Routine as security: A fixed morning ritual with enough time reduces rush. Shared breakfast, short relaxation exercise, positive outlook on the day.
The key: Take the pain seriously AND at the same time communicate that you'll find ways to deal with it together.
A bright spot
Psychosomatic complaints in children are highly treatable - especially when identified early and properly understood. Pediatric rehabilitation programs like FiPS (Family-Integrated Psychosomatics) provide a framework where children and parents learn together to understand their body's signals. The stress system cannot be switched off, but the way the body responds to stress can change. Children who understand what's happening in their body develop a way of managing their symptoms - and that changes everyday life.
Rehavio explains chronic conditions in age-appropriate language - what happens in the body, why therapies help, and how rehab works. Whether for yourself, as a parent, or as a professional.
