Thing 2

Pediatric Anxiety Disorder Anyone?

8313261279_49f6ae7c8b_z

Nikki has had stomach issues for awhile now. We’ve been to the doctor twice about it, done some exclusionary analysis, monitored diet etc. And we’re just settling in on what the doctor said originally that I refused to accept: Irritable Bowel Syndrome. (Not the same thing as INFLAMMATORY bowel syndrome.) The reason why I was so resistant to the diagnosis is because – in layman’s terms – it simply means, “She gets upset and her tummy hurts.”

It’s the cycle of diarrhea and constipation that – basically – she’ll just have to deal with her whole life and the only thing you can do is treat the symptoms. Treat the diarrhea, treat the constipation. Both of which are severe in their own ways. And not always in the ways that you would think, so treating is not always easy.

I had modern medicine with every ounce of my soul. While I think it’s brought us many great things, I also think that we often over-diagnose. We over-prescribe tests, surgeries, antibiotics. Everyone goes to the doctor with every fever, ache, and pain because no one wants to live with any discomfort without some sort of diagnosis, and that’s because the doctors always give us a diagnosis.

And I hate all of it.

But now? I wanted something real. I wanted an allergy to milk. I wanted Celiac disease. I wanted ulcers. I wanted something that we could actually treat. Not that this isn’t a real diagnosis – it is. But I wanted something we could fix.

The kicker? It’s triggered by stress. And my daughter? Has pulled every “stress” gene from every ancestral family member she could have and claimed them all her own. She gets stressed super-easily, she’s beyond dramatic, she cries at the drop of a hat and she berates herself for mistakes.

So, yeah. Not only is this a lifetime diagnosis but she’s also going to have a lifetime of coping with anxiety, which will inflame the irritable bowel syndrome.

And I hate all of this for her.

SO! This is what we do. Come up with good plans to treat diarrhea (with her the stomach cramps associated with the loose stools are what really impair her) and the constipation (pedia-lax doesn’t seem to be working) and look for the early signs of both so that we can, hopefully, treat them before they get too bad.

But we also have to start teaching her how to cope with anxiety and stress, and how to cope with her self-destructive behavior.

That’s where I come to you. Do you have a highly emotional child? We’ve been working on breathing techniques her whole life, and if we’re there to actually coach her? They calm her down. But she doesn’t do them on her own. I’d really like to talk to her about the feeling of anxiety and how to cope with that, but how do you teach that to a child? How do you bring it down to their level when they just classify everything as “happy” and “sad”?

Do you have a child with stress-induced stomach problems? How do you counsel them? I would love to teach her coping techniques because – as her doctor told us, most adults with irritable bowels go on anxiety medication to help prevent the stomach problems. And I’d love to help her build her own arsenal to deal with anxiety and stress, to help with that.

(And we all know – my only way to cope with anxiety is to eat. I’m trying to avoid teacher her THAT lovely trick.)

Any tips? And tricks?

65 thoughts on “Pediatric Anxiety Disorder Anyone?”

  1. Just sending hugs. My then 9-year old son had an issue with anxiety (and let’s throw in a little OCD and eating disorder just for fun). We tried seeing a psychologist, a social worker, a nutritionist, etc. He ended up taking a very, very small dose of Paxil for two years. It helped him immensely (and we hated the fact that he needed it, but he did).

    Would it help Nikki to speak to a therapist? Have you spoken to anyone at her school who can help? Good luck.

  2. I have IBS w/ constipation and it isn’t so much stress induced but due to diet. Hers may be due to stress but diet has to play a role…it is the digestive system after all. I tried more water and veggies but that didn’t have much impact. What helped me was the above and probiotics. I never had luck with the brands you can buy off the shelf but did with the refrigerated ones from a health food store. Get the ones that that billions of good bacteria. If she can’t take pills yet then open it up and put it in we oatmeal or applesauce.

    Hope you can get it under control soon!

  3. I would check to see if diet plays a role too. I have met several folks that have had some version of what you are going through with Nikki and been told that they or their child has IBS and to treat the symptoms (constipation, diarrhea, etc). They eliminated gluten for a week and could see a big change in the symptoms in that time period after being told that gluten had nothing to do with their problem. Of course the ones I am most familiar with deal with gluten but you could try to isolate other foods too like dairy, soy, etc. It doesn’t have to be an autoimmune disease like Celiac. It could just be an intolerance to something that is messing with her system. I swear I don’t think gluten is the root of all evil but while you are trying to help her to learn to deal with her stress maybe consider experimenting with her diet a bit. There is still so much to be learned about food intolerances. I am very sorry to hear that she is suffering so much. 🙁

  4. I have read your blog for quite a while and this is the first time I’ve commented. I know – the silent stalker! This entry hit home – I am that kid and my daughter is that kid. I was diagnosed with a spastic colon at age 5 or 6. I would get a horrible stomach ache anytime I was stressed or worried about something, but back in the 70s they didn’t associate a child’s pain with stress or anxiety. I developed migraines in junior high and ended up in the emergency room the night after my first day of high school. The first time I saw a counselor/therapist was when I went though a divorce (in my early 30s) and she associated my stomach pain with stress. So, it has only been the last 10 years or so that I have been treated for anxiety – through counseling and medication. That’s me, but in 1999 I had a beautiful little girl. At about age 3 she started exhibiting some of the same issues (also right around the time of the divorce). So, I took her to a fabulous counselor. Our Miss Elizabeth taught my daughter about breathing and gave her other skills to calm herself down. We still use a scale of 1 to 10 to rate anxiety, use the question “How big is the fire?” – the fire being the feeling of dread or worry, and the question “What’s the worst thing that can happen?” when she is worried about something in the future. Most times that puts into perspective the level of worry that is needed or OK. Miss Elizabeth also made sure that my daughter knew that worry is OK – it’s one of our body and brain’s forms of protection. We just can’t let it rule our life or make us miss things that we want to do. She is 13 now and most times she and I can talk about things and at least calm her down – not make the worry go away, but deal with it.

    I hope my little life history of axiety helps you and Nikki. It’s hard for a kid to have those feelings and not know how to handle them, but sometimes I think that it is worse for the parent. You want to fix it, but you can’t. You don’t want your child to feel bad (emotionally and/or physically) and you feel helpless.

    If you have any questions or I can help please send me an email.

    Janette Peggs

  5. Oh God. I WAS that kid, minus the IBS. Things Mom & Dad did that helped:
    – Teach me to use exercise (include yoga, because it can be done anytime) to reduce stress.
    – Watch how they framed their expectations, because I would internalize them. And then taught me to frame my own expectations reasonably as I got older.
    – Taught me to ask ‘what’s the worst that could happen?’ and helped me be realistic about that. Usually, the worst that can happen really isn’t that bad if you’re honest about what it is.
    – Made sure I ate and slept well.
    – When I got to high school and took a really hard truly stressful program, Mom periodically would insist on ‘mental health’ days. Days when I stayed home from school and worked on big papers, slept – whatever I needed go regain control of the situation. (I did that as an adult and even pushed people I supervised to do so when they needed one.)

    I’m sure there’s more, but that’s what I see when I look back and when I consider how I handle stress now.

  6. My friend who struggles with anxiety suggested maybe giving her a card to carry with her that gives her instructions on what to do when she’s on her own? Like pictures and short sentences that help guide her to relaxing?

  7. I’ve had SUPER stomach issues as well, been to specialists, gotten a colonoscopy, had EVERY test done, and done EVERY elimination diet. I have ZERO diet or food related triggers. It is ALL emotional (with a side of autoimmune) for me. So no, it absolutely does NOT have to have a diet connection.

  8. My own child had some issues with constipation, which was brought on by a stressful event (her grandmother died of cancer when she was 5) and she’s pretty much struggled with it ever since but without much of the drama.

    But the child I currently care for, has definite digestive issues brought on by anxiety. He was diagnosed with acid reflux when he was about 5 or so, and needed medication to heal erosions in his esophagus. I wasn’t caring for him at that time and since then I have pretty much concluded it was actually his peanut allergy that made him throw up which then caused the erosions. Others had decided since he stopped having any skin reaction to eating something with the label warning “may contain peanuts” he’s not allergic anymore and started giving him various cereal and granola bars which would always cause a tummy ache. So, he learned that, when his tummy hurt, throwing up made it better.

    But then there are times when his tummy hurts because he’s upset. When he’s about to go to the dentist to get a cavity filled, or to his yearly exam at the doctor’s office which includes a flu shot. And sometimes when he gets disappointed about not getting to do something he wants to do, or when he’s faced with a new food to try. All these anxiety producing events cause him to work himself up into a mess and he either throws up or has diarrhea when the breathing and pep talks don’t work or if his father or I can’t get to him fast enough to manage his anxiety. His mother can be very soothing and can do the same things. And since she suffers from much the same anxiety problems you’d think she’d be extra cautious about his. Instead she keeps trying to force him to “man up” and often goes from “poor baby” to “cry baby” in the same talk with him, which helps nothing and is a big reason he’s all mixed up to begin with. Not comparing your behaviors to her, just giving you the background for him.

    The deep breaths along side reminding him of prior events which went fine, help get him through, and to sort of alleviate just the tummy rumbly feelings, I offer him a peppermint. And in severe cases I’ll even give him two, and sometimes I’ll even break out the antacid meltaways that are peppermint flavored. Peppermint calms the stomach, as does ginger, but since it’s hot like cinnamon it’s not usually well received in candy form, but they do make it (I’ve seen them at Oriental restaurants.)

    I also agree with giving her lots of probiotics, If she’s a yogurt eater I’d start there. And if necessary get the pills to add to her diet. And possibly see if ginger can be added to any of her meals.

    As far as getting her to actually start the breathing on her own, it probably isn’t that the breathing itself is helping it’s the support she gets when you, E or Donnie walks her through it. So I suggest approaching that a little differently and when an event starts instead of immediately telling her to breath, ask the question, “What should you be doing to help calm yourself now?” And try to gently urge her into it and hopefully in a while she’ll ask herself that when she gets upset and you aren’t around. And be able to manage her own anxiety a little better.

  9. I love the scale of 1-10 idea and the “how big is the fire” concept. I love Miss Elizabeth vicariously through you, is that okay? 🙂

    And with helpful information like this, you should comment more often!!!!!!

  10. I love the idea of watching how they “frame expectations” because I think that’s a lot of her problem. Thank you so much, I also like the idea of a personal day sometimes!!!!

  11. Hi Zoot,

    My daughter is also a type A stressor who internalizes EVERYTHING. We do a lot of exercise and yoga. Yoga is amazing. She goes from wired to calm with one 25 minute video. We live in a small town, so there aren’t any yoga classes, but if there were, we would do it. For Sophia water is always soothing. So during the summer we buy a pool pass and she lives at the pool, which is great – water AND exercise. We also stress time away from technology – for example she has to be in bed at 7:30, but she can read quietly until 8. She also gets a lot of comfort from her kitty, we specifically looked for a slightly older kitten who was a known snuggler. Blue follows her around the house and loves nothing better than sitting in her lap and being…. aggressively cuddled. We do a lot of hugging. She’s a hugger.

    But yoga. It is amazing.

  12. Yeah – the diet thing has been tricky because we’ve been doing exclusionary tests for awhile and seen no consistent results that follow any logical pattern. We know that we have to deal with diet issues when there are actual symptoms (No cheese pizza and milkshakes when she’s constipated :)) but when we excluded stuff, we actually saw opposite results than what we were expecting. Like, when we tried to exclude gluten we saw a quick swing between stomach cramps/loose stools and constipation. It was weird. BUT – that week was REALLY Stressful for her – so that’s when I started kinda thinking that maybe the doctor was right about stress. ::sigh::

  13. “reminding him of prior events which went fine” this is something I’ve been trying to do with my own history since she doesn’t have a lot of experiences yet. Trying to see that I lived through the stress she’s suffering 🙂

    “it probably isn’t that the breathing itself is helping it’s the support she gets when you” I think you’re right because it’s always more than breathing, it’s always affirmation from us too. Like “it will be okay, Mommy’s here,” etc.

  14. Yoga might be a great thing to try for her! I wish she liked our pets more (grin) because they’re all snugglers!!! I need to work on the bedtime thing, the day I had to pick her up from school with horrible stomach issues? She napped for 2 hours. And she NEVER Naps anymore. So sleep may be playing a HUGE factor in it.

  15. With Sophia we have to keep her on a pretty set schedule. When she goes off her schedule it increases her stress level and I can tell because her behavior shows it! We try to eat dinner at the same time, then bath, then “free time” (TV, books, games) if she has time, in bed by 7:30 (lights out at 7:30 if she’s been a crab), then lights out at 8.

    Sometimes it’s a pain, but her stress level just skyrockets if we don’t keep her on a schedule (especially with her sleep). With her it doesn’t get expressed as tummy troubles, she gets migraines. 🙁

    The other thing we have to keep an eye on is her food intake. We try to keep snacks out all the time that she can grab. Things like fruit and veggies. She is allowed all the fruit and veggies she wants and all the water she can drink. I do notice if her diet goes carb heavy her stress level is increased, so then we cut out that stuff and push the fruit. It doesn’t help that she’s the pickiest child in the world… but we try to keep things in the house that she’ll eat.

    Have you had her vit D levels checked? You could try that.. Up here in the frozen north almost everyone is vitamin D deficient.

  16. I’ve heard really good things about _Freeing Your Child From Anxiety_ by Tamar Chansky. I’ve read parts of her similar book about negative thinking, which is really great. Lots of typical self-help stuff, but presented in a way that is very kid-friendly.

  17. Agreed those are both excellent helpful things to do, it helps make something vague and abstract, tangible and quantifiable. And kids understand and deal much better with things that have more substance and aren’t just hanging out in the ether of the grownup world of language they don’t quite get yet.

    Is there anything specific that Miss Elizabeth suggested you do for a fire of 8 as opposed to a fire of 3? Or is it just as a way to have something to compare apples to oranges and say, “well you dealt with the situation last week that was a 4 and it turned out ok, so you can handle this too”? Because I don’t suspect I could convince the child I care for that anxiety about eating sweet potato fries is at all similar to performing in the spring concert in his school choir. But if he gave me the same fire level for both he’d be able to associate why I was saying it was similar.

    We have already used the ‘worst case scenario’ idea however we have to be careful about it because sometimes he gets worked up over fears about being hurt. What if a car hits me on my way home from the bus stop? What if the stairs collapse with me on them? The worst thing that can happen is of course that these events DO happen but just very rarely and we can’t live in fear all our lives of minute risks associated with leaving the house regularly.

    I do hope that all these anxiety riddled children find relief. Childhood is supposed to be so much more carefree and I hate seeing/hearing about so many suffering for no reason. Because while worry is normal in small doses, the over abundance of it, alongside children who have little concept of identifying what they have control over vs what they don’t, is just needless pain and wasted energy.

  18. With my daughter “the how big is the fire” kind of went hand in hand with the 1 – 10 scale. It’s getting to the idea that what they are worried about is never as big as they can make it into. We always called it turning down the drama queen with my daughter. With anxiety, even the smallest worries can escalate into an “end of the world” idea in a child’s mind. When she was little, I could make it silly – “What’s the worst thing that could possibly happen? Will your head explode or your arm fall off? Will the earth open up and swallow you whole?” As she’s gotten older, we talk about the difference between being uncomfortable and being hurt (emotionally or physically). It’s good to be uncomfortable sometimes.

    We always talked about how it was OK to be worried or nervous or scared. I wanted her to understand that there was nothing wrong with her and that those feelings were normal. We just couldn’t let them take over, run our lives or keep us from doing something that we wanted.

    I think I probably learned as much from Miss Elizabeth as Macy did. If you can find a good counselor (not someone ready to feed your kid meds) that can talk and relate, I highly recommend it. We went for about a year and have continued to use the things she taught us just adapting as she grew.

  19. I just read that and wanted to comment on my own “meds comment”. If medication is needed I wholeheartedly agree that it should be taken. I’ve been on my own anti anxiety/depression meds for several years and wish I had had them long before that. I just think that there are some kids that can benefit from learing skills and work to control their anxiety without medication. Fortunately, my daughter hasn’t had to go the medication route yet. As she gets older and her body and mind change, that may change.

  20. Did you try eliminating artificial sweeteners? ALL of them…they affect my digestive system in ways that are horrifying~~~

  21. So I had this as a kid. It would really present when we went out to dinner because for some reason I was hung up on the idea that I was going to get poisoned (I have no idea why probably because all of my caregivers watched Guiding Light). At some point my parents took me to a therapist and I learned breathing techniques that still help me (in with the good- out with the bad on each inhale & exhale). Now meditation really helps me manage my anxiety. There’s some pretty good guided mediations for kids like this one: https://itunes.apple.com/us/podcast/inner-peace-affirmations-for/id164025012?i=15561150&mt=2

  22. Man, I was that kid. Of course no one understood that it was anxiety-related back then and it got progressively worse until my early twenties when I had to have an emergency bowel resection! I was eventually diagnosed with Crohn’s disease, but I wound up moving to the west coast and learning about alternative and energy medicine (while still seeing my gastroenterologist) and after a year of that, I went off my Crohn’s meds and never had a problem again. I like what others said above about learning to take deep breaths to calm yourself (I do that today), framing expectations, and yoga. Meditation is super helpful for me, though I didn’t learn to meditate until I was an adult. Another thought is Reiki. I’ve found that learning Reiki and using it on myself has helped tremendously. http://www.reiki.org/faq/whatisreiki.html

    It’s so wonderful that you’re helping her with this now… she is so lucky to have a great mom and a great doctor who are trying to ease the problem from all angles!

  23. I understand Janette, and agree again. Medication can be a wonderful thing but it’s not a fix, it’s something to help and in a lot of cases should be short term with the intention of teaching more coping techniques and allowing for a little more time for the emotional maturity to come along without the suffering. The boy I care for was also diagnosed as ADHD and we spent a year doing just the coping techniques and giving him better strategies to stay organized and all of those things reduced his general anxiety quite a lot, but only when he’s in a structured environment, as soon as he has free time he’s back in an out of control mode and since that mostly is happening at school during lunch, recess, and in the school yard while waiting for his bus, medication was necessary. Plus, when a child is putting twice as much effort into life, just to stay stable most of the time, and you can relieve some of that, it’s almost cruel to withhold the medication. He could have struggled through all this, and continued onward, doing ok in school grade wise, but he probably would have gotten suspended for his behavior at lunch/recess/schoolyard times and sent spiraling downward from all that negativity. We’ve just started the medication, it’s at a very low dose and we’ve made it clear it’s not fixing him because he’s not broken, he just needed some help to control impulses and to keep focused so he can be the kind of person he confirms he wants to be. The ongoing problem was that he would do things, feel bad for them, start a self hatred/self punishing cycle and his mood would decline, until eventually he was in a “damned if I do and damned if I don’t” mindset, and repeat that so that he never feels good about himself and you’ve pretty much got where we started with him. We have gotten him to break the cycle, and to recognize that it’s significant that he does feel bad, and the important thing is to make better decisions and learn from mistakes not to just feel bad about things. And I should probably mention he’s only 8 years old.

  24. Poor Nikki! And you. I’m sorry.

    I have always been somewhat high anxiety, even as a kid, though I don’t know/remember how it presented so much when I was a kid. When I got older, some of the tricks that helped me were types of meditation. One: when worrying about something, I would close my eyes and just let my brain wander, and anytime one of the negative thoughts came up I’d yell (or think in a yell) “stop!” The goal is, eventually you can do this without so much effort and your brain gets trained to stop the negativity. Two: similarly, closing my eyes and focusing on the physical reality of what was going on. Like, the floor is hard, my sweater is soft, etc…Keeping myself focused solely on the present and not letting any theoretical stuff creep in.

    These may be kind of advanced techniques for her, especially to try solo, but maybe you can make it a game to teach her the basic ideas and do it together? I don’t know.

    And I second the sleep and schedule. I still get “nervous tummy” NOW if I don’t get enough sleep, or if I eat too much crap in a day. It’s not a diet situation, per se, more that my body needs good fuel to keep my emotions and brain happy. Food coloring, too much sugar, those things tend to make me more anxious.

  25. I was discussing this with you on FB and will continue over here if you don’t mind. Yes, we deal with some similar things both stomach and anxiety wise (in a variety of 7 yr olds!). We use deep breathing to calm down massive freak outs. Exercise helps long term and in, “go jump on the trampoline for a few minutes” methods. Lack of sleep or illness makes it worse. We recently implemented sleep time tea and calming lotion before bed time when it really rears its ugly head. Good luck.

  26. Yeah – I don’t think she would get those in any way…but I’ll keep an eye out just in case!

  27. We’ve done our share of exculsionary experiments and the only consistent results we found seemed to still connect to stress. For example, the week we took out gluten, she had BOTH episodes of diarrhea and constipation…BUT…she was having a very stressful/rough sleep type week.

    But we are still looking to adjust food/diet based on the phases of the cycle she’s in, so that we can try to keep from making it worse, if that makes any sense!

  28. Nikki’s cycle is similar, She does something she get’s in trouble for, she hates herself for it, then she acts out by doing something she KNOWS she’ll get in trouble for…I think we’ve done a decent job of breaking that particular cycle because I think she was shocked when we pointed it out, like, “Wait. I do that and you’re right, it just makes things worse!” but she’s not had the same realization with some of her other behaviors.

  29. I haven’t had her Vit. D levels checked, but we are lucky down here and she gets a LOT of outdoor/sun time even in the winter. I do need to do better about keeping her on a schedule, though. I know for a fact that is a huge issue we all face!

  30. I’ll look into those, but I really think that eventually we’ll have to talk her to an expert to guide her because – I think she maybe blows us off a bit (WHAT? I KNOW!)

  31. The fact that you were able to get away from some of the digestive issues gives me hope for her!!!!

  32. While these type of suggestions might be a tad mature for her, I think I’m still going to maybe implement them into affirmation cards for her to carry around. Something she can look at if she gets stressed, you know? To remind her of those type of things?

    Also..THE SLEEP…we have got to be better about that.

  33. The calming lotion is GENIUS. She reacts strongly to soothing touch and stuff, she finds it relaxing. I definitely need to get her on a sleep schedule b/c she’s like me and her emotions plummet if she’s tired.

  34. I’ve got a super-anxious kid (she’s 5) to the point that she saw a play therapist for a little while. One thing that we do with her is talk about the purpose of fear/anxiety/worry. Why we have those feelings. So: our brains make us feel fear or anxiety to protect us. And that can be a good thing. Like if you’re standing near a cliff and you get a fear of falling over it — that fear is helping you because now you know to be careful when you’re near a cliff. But when you feel that same fear over (insert mundane thing here), the fear isn’t doing its job. So more often than not, with her issues, we have to talk about how the fear/worry isn’t doing its job. Silly old fear! Do your job! (We say these things and it brings some levity to the situation when she’s upset.)

    Another thing we did recently was work out a Worry Plan. It’s basically a checklist of things to try when the worries get too big. We wrote it down together, then I made a simple/visual chart for the wall. So when she comes to me and says her worry isn’t doing its job, I can say, “Oh no, let’s go over the Worry Plan.” (Or if she hasn’t clued in to the fact that her worry isn’t doing its job, I’ll bring up the Worry Plan, or point to the chart.) I have seen her seek the chart on her own, though I do have to remind her of it more often than not so far.

    Our worry plan is 1. ASK: Is my fear/worry doing its job? 2. Blow on soup. (That’s our version of deep breaths) 3. Wave goodbye to the worry. Tell it to stay away! (She literally does that) 4. Draw a picture of the worry. 5. Quiet time in my room. 6. Tell mom or dad.

    Another thing we’re always working on is giving her a vocabulary for her feelings. So when she says (in the middle of a huge sobbing fit), “I’m SAD that you said I got the question on my homework wrong!!!” My response is, “I can see that you’re very upset that you got the question wrong. Being wrong about something doesn’t feel good because you were trying so hard to get it right. But THANK GOODNESS you made that mistake because now we can learn something together! Making mistakes is part of learning.”

    That way she’s learning the words for the nuances of those negative feelings, feeling validated, and given something positive to focus on.

    So that’s some of the stuff that has worked for us! Your mileage may vary, of course.

    My sympathies to you and your kiddo. For you because I know it’s tough to help an anxious kid learn to manage her feelings, and for her because I know from watching my own kid how scary/unsettling it is to feel like you can’t control your emotions. Hang in there! You’re basically the best parent ever, so it’s gonna work out fine. 🙂

  35. Oh, HEY. We also took her to pick out a bracelet with a charm on it and called it her calm bracelet. When she gets upset, she’s supposed to hold the charm in the palm of her hand, or “worry it” with her other hand. We’ve had some success with that — it’s a visual reminder to calm down and gives her something else to focus on when she’s feeling upset.

  36. Along with the 1-10 scale & fire analogy, one of the people I follow on Twitter said that her parents reminded her that even if you have to eat an elephant, you can only do it one bite at a time, and when she was really stressed they would ask her what size animal she had to eat, and help her figure it all out.

    One of the more effective treatment modalities for anxiety is Cognitive-behavioral therapy. Not long ago, I saw a great social story about this geared towards children with aspergers, and it talked about “poison” thoughts and antidote thoughts. Found it!: http://autismteachingstrategies.com/autism-strategies/cognitive-behavioral-therapy-and-aspergers-high-functioning-autism-visual-strategy-downloads-for-helping-kids/

    This one looked good too; http://autismteachingstrategies.com/autism-strategies/cognitive-distortion-thought-bubbles-simple-cognitive-behavioral-method-for-kids-with-high-functioning-autism/

    We have a yoga app that’s geared towards kids on our ipad, the adventures of super stretch, and it’s a nice & calm introduction, that even mentions the benefits (this one is good for an upset tummy, this one is good to calm your mind).

    As a school pschologist, I would highly recommend talking to her teacher as well as the counsleor and nurse at her school about giving them some resources that you are trying at home, so that she’s hearing a consistent message, and has places to go to calm down when she needs to for a few minutes. They should accommodate this without too much fuss.

  37. Saw your tweet when my sister, @devivo, RTed you. I had a nervous stomach as a kid and teen. I would get nervous about something, then vomit. I spent my grandpa’s fancy retirement dinner in the bathroom trying not to be sick, because being at a fancy restaurant was too stressful. And I cried… a lot.

    The fixes I found for it, other than growing up and becoming more independent, were getting enough sleep and eating enough protein. To this day, if I find myself feeling a bit weepy, I probably need some protein and a nap. I’m 35.

    I would also suggest reading the book Quiet by Susan Cain. It is a book about introversion and has a great chapter on how to parent an introverted child. Your comment “she berates herself for mistakes” is very familiar and I now attribute it to introversion more than anxiety.

  38. I was/am that person. And right or wrong I guess I’ve always taken a more practical approach – maybe because I also have other chronic illnesses that you just learn to live with. It is what it is, no amount of stress reducing exercises are going to change it or make it go away and the best thing for me is just to have a plan and be prepared.

    I keep toilet paper in the car during long drives or all the time. Tissues in my purse always. It is bad enough having an unexpected “episode” it’s worse when you can’t manage it with embarrassing yourself.

    My approach is this: Things are going to happen and I will suddenly get stressed and have to go to the bathroom. Worrying about how/when I can do that only adds to that stress. So have a plan. In school I knew the shortest route to any bathroom – so if I was handed back a “C” on a test and I felt my bowels turn to liquid on the spot – I had a plan. During one really terrible time in my 20s when life sucked and I was expecting to get fired any day, driving an hour to work in rush hour traffic meant keeping a plastic bag under the drivers seat of my car. As an adult I carry Immodium in every purse and bag. Just like other girls do tampons/pads.

    Which brings me to something else – over the years as I hit puberty – I noticed a direct correlation to my monthly cycle also. Now I know she’s too young for that now but watch for it in the future. I would not “go” much the 2nd 1/2 of the month and then when that week came – it was like purging time with all the associated pains. It helped me to know this routine was on it’s way each month and to expect it. I didn’t stress over trying to figure out what was stressing me.

    One thing I’ve learned over the years is that does help is to try and do things to be as “regular” as possible during non-stressful times. Fruit, fiber, water, yogurt what ever works for her. If you are starting from a regular baseline it’s easier to get back to “normal” than if you’re all over the place to start with.

    I guess my point is this. If you can do something to reduce it great. If not, teach her to live with it. Help her accept that it is a part of her daily life and find what is going to be the best way to cope, plan, and prepare for the inevitable challenges.

  39. Metamophicshifts – Metamophic shifts comes from the idea of tectonic shifts. That is the the earth is in a constant state of change. Like the earth's very surface, we are constantly in a state of change whether we want to embrace that change or not. As a certified coach, I have a front row seat to the process of metamorphic shifts in humans. People cling to certain thoughts and beliefs about themselves. Coaching works as an activation mechanism to change, growth and transformation. I have spent my career exploring human nature through fundraising, recruiting, and most recently coaching and leadership development. I am a single working mother of two children who light up my world but have also taught me as many lessons as any work I have done. My other great joys in life including running, health and fitness, exploring the natural world, reading, writing, and learning as much as I can soak up about all of these topics. My hope here is to share some of my experiences, develop some action items for myself and maybe in turn help some readers, and really at the end of the day get myself to write and explore my voice a little more. Education and Certification: Bachelor of Science, Health and Fitness Management Masters degree, Public Administration CTI Certified (PCC) Coach IIN Certified, Health Coach EQi Certified Immunity to Change Facilitation Trained Keirsey & MBTI Experience
    Christina says:

    My son has some similar issues. He gets severe stomach pains and massive headaches. He will be EIGHT in April. I am like ‘you are too little to feel this anxious/stressed out/scared/nervous’.

    I am pretty much the crappiest example of how to teach him to be less of any of those things as I just had a upper GI endoscopic test and my teeth are decaying because of whatever is going on inside of me from mismanaged stress/anxiety. I have had tummy troubles and migraines most of my life especially in stressful times. The anxiety really took over in my 20s and I never realized that I used to binge drink to cover up my discomfort with social situations until I mostly stopped drinking and had to be in social situations sober. I honestly I have just let the anxiety and stress take over my world the past few years so I do feel a sense of sorrow that I have “taught” him this behavior but I cannot change what is done now and of course I know genetics are a part of this as well.

    We have tried every trick in the book to help him with his troubles. I do find the more we do, the more tired he is, the more hungry he gets, etc… the worst these things get. Basically we are working on eating right, drinking plenty of water (huge issue especially with sports), and sleeping well. We are using a workbook style book called What to do when you dread the bed: A kid’s guide to overcoming problems with sleep. This is a really neat book, he loves it which surprised me! There are fun interesting magic tricks to do in between the what we can do to help with his sleep issues. I mention this because they have one called What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety: http://www.amazon.com/What-When-You-Worry-Much/dp/1591473144/ref=wl_it_dp_o_pC_nS_nC?ie=UTF8&colid=222WUTDJFPYGD&coliid=I3W4Z577PLG4GR

    We also have “I am scared” triggers. He is scared of the weather and the dark right now to the point paralyzing him. He has trouble sleeping, going to sleep, staying asleep, getting enough sleep. I think a huge chunk of this has to do with being very sensitive. He does not like to harm people and he is very touchy about being harmed but he is also not good at sharing what is bothering him so we are left to guess until he blows up (sobbing, melt down explosion, or just sick to his stomach headache pain.)

    I have had this book: http://www.amazon.com/Calm-Compassionate-Children-Susan-Dermond/dp/1587612763, since my son was two and we started struggling with this even then. A teacher at the large daycare center he attended suggested I read it. Of course, I wait till now to start on it. It is basic stuff but it is helpful and a great reminder of things I can do better or I am not doing at all or we have stopped going over the past couple of years. Point being, I think there are some fantastic books out there.

    We have considered a therapist for him to help him talk through things and not with us since he seems to respond better to outside sources better than to us but for now we are working on managing things on our own. I talk to him about being calm and finding a calm place in his head. We practice breathing when he is worked up (in the process of getting worked up or worked up already to the point of hyperventilating) He has a special mental box for scary things (like the weather.) If he is scared and there is no real reason to be – it is a cloudy windless day but it seems scary to him – we say put that fear in the box for now. We promise nothing bad will come of this day, we look at the weather forecast together, and then we talk about how safe it is. We remind him of his box if he mindlessly says I am scared (of the weather). It has helped but there are definitely moments… it is hard. I hope you can find solutions.

  40. You would be surprised- yogurt, candy, different beverages…I’m pretty vigilant but every once in awhile I slip up an know it immediately!

  41. I think I’ll try to at least talk to her counselor, because I think you’re right and they’ll probably have some even better suggestions. THANKS FOR THE LINKS!!!!

  42. I have heard of that book when I’ve talked about my “introvert” tendencies – I really need to check it out!!!

    And I don’t know if it’s protein or not, but if I’m hungry? I get highly emotional. I can not skip meals. At all.

  43. I think there’s extreme value in teaching her how to cope. The worse part for her is the constipation right now and hot baths help, but are (obviously) not at all convenient. I definitely want her to be prepared to cope for anything her digestive system does.

    Do you know who Hank Green is? He does a channel on YouTube called Vlogbrothers but he did a video recently on his personal channel about living with ulcerative colitis and a lot of your suggestions reminded me of stuff he talked about which I thought was SO HELPFUL.

  44. I cope with my own stress by over-eating, so I hear you on struggling to each your kid what you haven’t learned yet!

    Thanks for help with the resources, I honestly think sleep is a huge issue with her b/c many days our schedules are hectic and not at all consistent.

  45. I was an anxious child in the 70s and they did relate my stomach issues to anxiety, but I don’t think any solutions were offered except that I didn’t have to eat in the school lunchroom, I could eat by myself in a classroom. For a while I was very phobic about any kind of public eating situation. I once stayed in the car while my family ate at a restaurant. It took me until I was around 30 to figure out I was lactose intolerant. When I was a kid, I was really afraid of trying new food – especially away from home. I think subconsciously I was trying to protect myself from the stomach aches. I had other fears such as the dentist, but once I went and realized it wasn’t so awful/painful as I had been led to believe by books, tv, etc., I got over that. I would say I still have a fear of the unknown and I ignore the stomach pain that accompanies me. Maybe a worry stone Nikki can keep with her and rub might help, or even the motion of rubbing her thumb and finger together. I still use one when I can’t sleep and feel anxious.

  46. Yet more ways that our lives parallel Kim. Myself and my parents diagnosed with anxiety disorders, I’m on meds. Son, aged 6, showing signs (minus the stomach issues), so we’ve tried to prepare him for it. Here are a few things that work for us:

    LOVE this book for framing the subject: http://www.amazon.com/What-When-You-Worry-Much/dp/1591473144/ref=sr_1_2?ie=UTF8&qid=1358878854&sr=8-2&keywords=kids+anxiety

    We talk about being a ‘problem solving family.’ I found with my own anxiety that I would get worked up with the problems/issues/complaints, and never moved on smoothly to fixing/action/solution thinking. So when either of our kids start worrying out loud (or whining for that matter), we challenge them to come up with solutions rather than focusing on the problems. It also helps if they see you switch your dialogue from stressing to problem solving.

    As mentioned in another comment, we use the ‘worst case scenario’ conversation, and add in silly ideas to take the edge off the stress.

    You’ve got some great ideas in the comments. I’m going to snatch a few of those myself.

  47. i have a six year old who can be over emotional and while I’ve tried teaching her yoga – she’ll do the breathing with us if we are around and doesn’t think to do it herself. I know this has Elmo ,and therefore may seem too baby-ish, but it seemed to help my girl remember to breathe to get her anxiety and anxiety-related anger in check:

  48. Ugh, I’m so sorry for Nikki and for you. I’ve never really commented, but this is something that hits way too close to home.

    I’m 31 years old and I was Nikki all my childhood. All the doctor visits, the tests, the procedures and no definitive answers. My mom and I both just wanted it to be *something* – something that you can treat. But all my doctors could come back with was IBS. What’s worse is none of the medications they use for IBS did anything for me.

    I have a habit of internalizing all my stress and feelings (hello anxiety!!) and I think it always made things worse. I spent a good chunk of elementary school in the nurse’s office with a stomach ache. Of course it wasn’t until my late twenties that I managed to figure out HOW to manage it all. Firstly, there’s always anxiety medication in my purse. I don’t take it all the time, it’s more an “as needed” prescription but it helps. And I know from the comments there’s been a lot of mention about nutrition but that’s just a small part of it. One day something will make me sick and the next I’ll feel fine. The only consistent foods that give me trouble are fatty, fried or super rich ones.

    Finally, breathing techniques help for me. I’m not talking meditation or anything, but when it hurts or when I’m stressed some deep breaths help a lot.

    *hugs* to both you guys.

  49. Great video and so true! His approach seems a lot like mine when it comes to living with Chronic Disease and adjusting to what is your new normal. It doesn’t mean it’s the end of the world – it’s just different the best thing you can do is get over the drama of it and move on.

    That and high five on the 95% chance if you’ve talked with him on the phone you’ve talked with him while he’s going…… Happens. All. The. Time.

  50. I had a nervous stomach as a kid from anxiety too, though mine was more nausea and vomiting than intestinal problems. I had every test under the sun, multiple upper GIs, had to go on elimination diets, etc. It was just from anxiety and I grew out of it for the most part as a regular thing.

    I do still get extremely nauseous when I’m very nervous about something, which is rare these days. And a few years ago, when I was working a job I absolutely hated, I got sick every day on the way to work. It was ridiculous and I ended up having to quit because nothing else I tried (medication, breathing exercises, etc) worked. When I quit it stopped. My job now is significantly higher stress but I am able cope better with the type of stress, I guess.

  51. So much of it is just genes – that’s half the battle. This runs in families and it is REAL. My sister and I both dealt with it at early ages .
    Mom had it along with the anxiety/depression. I have battled it my whole life. I remember anxiety so bad I couldn’t make the car ride to school without mom stopping because I had to go to the bathroom. That started in second grade. The summer before my freshman year they had to hospitalize me. After a bunch of tests they told mom I needed to be treated for my anxiety with meds. That started years of me feeling weak/not taking my meds etc till I finally came to peace with it all. I need medication to function. My brain does not fire right without it. Obviously Nikki does not need medication at her age. Exercise is the best outlet for her. I really think that helps. Just be supportive and reassuring .It’s a tough thing to deal with and a vicious cycle.I hate it for her!

  52. Hi there,
    Just adding that the book The First Year–Irritable Bowel Syndrome An Essential Guide for the Newly Diagnosed really helped me understand it better–the author suffered from IBS since childhood too (Heather Van Vorous). And it sounds odd but taking fiber pills daily has been a god send for me as well as eating foods in a certain order as well as managing stress. Take care–I love your blog and you’ll both be in in my thoughts.
    Julie

  53. I have suffered for my entire life from what my mom and I always called “nervous stomach”. Basically, anytime I get nervous or stressed I bet blowing, horrible diarrhea. My best way to fight it is to treat in advance. Carafate always worked really well for me but nowadays I just make sure to have a steady supply of Imodium on hand. Especially now that my 14 year old daughter seems to suffer from it as well. Before big tests, first day of school, dances, etc we just start to treat it before it has a chance to get out of hand.

    I feel for her. I know how bad it sucks to have the upset stomach and worry that you’ll have to be at the bathroom at a bad time. Give her a hug and tell her that there are other girls out here that suffer with her. A Sisterhood of the Nervous Stomach!

  54. I think the point scales are a great way to go. I am a special Ed teacher and work with a lot of kids with anxiety issues and those have really helped. One of my favorite ones is a 5 point scale that you write in next to the numbers what it looks like, feels like, and what you can do about it when you feel anxious. I have found these are a great starting point to help kids identify within themselves when they are starting to feel stressed. It’s a good place to start with young kids and then they can move into a 10 point scale as they get older.

  55. Other people have some really great ideas…so I just want to send some love and hugs your way. Someday I’m going to get myself qualified and finish training and get a job where I can help kids who are struggling… but for now….lots and lots of love and hugs.

  56. Can’t help with the anxiety coping strategies, but we battled several months of intractable constipation with my daughter and I wanted to share something that helped. These bran muffins really did the trick and worked better than any other food to help keep her regular–lots of bran, whole wheat flour, and prune puree. And they taste much better than your average bran muffin. They are a bit of a pain to make, but I would make a double batch and keep them in the freezer. They can be heated up in the microwave as needed. I usually add raisins (my kids love them), substitute whole wheat flour for the amaranth, and I just fill up my muffin pan like normal: http://projects.washingtonpost.com/recipes/2010/05/05/molasses-bran-muffins/

  57. Maybe you can ask her to visualise the belly breath =P vid posted above, and ask her to do affirmations I love my tummy just the way it is. Or perhaps she can visualise a happy color or rainbow? I find yoga really helps. I am sorry for Nikki’s tummy troubles, and hope she gets better soon!~~xxx

  58. You know I berate myself when others don’t. Totally get the crowd here. =P So useful comments. xxx I think perhaps it’s introversion for Nikkiz. I mean it’s not obvious when she has a bright and cheerful manner, but she can still be more of an introvert, sensitive, and more empathetic. xxx POI

  59. I was diagnised with IBS when I was, maybe, 13 and we found over the ensuing years that some foods are triggers… I’ve since cut out most gluten, and oranges and for the most part I have no issues… give the random too much stress and too much starchy and or acidic foods. Conversely, I drink water with lots of lemon (alkalizing citrus) also for balance
    p.s. I will soon turn 36.

  60. I was a highly emotional child, and had diarrhea from the time I was about 9, until about 25 when I finally learned to cope with my anxiety.

    Now, I have a son who is also HIGHLY emotional. Cries about everything, explosive upsets about the smallest frustrations. He gets embarrassed really easily, to the point where it’s crippling. I have three other kids, besides him, and it was starting to negatively impact the little kids.

    So we started some basic behavioral cognitive therapy at home. And it’s working. Really well, actually. When he starts to get worked up, we pull him into a firm hug. Sounds silly, but the physical contact helps recenter him and helps him bring his emotions back to his body. Then we talk about whatever is bothering him. We’ve taught him that how he feels isn’t wrong, that he’s entitled to his feelings. He gets a chance to cry about whatever, and then we talk about it. We ask questions about his thought process, to try to help him see that there are other ways he could perceive the situation.

    We’ve also taught him that he doesn’t have to hold onto his feelings. LIke, he can get upset, feel them, and then let them go like a balloon in the air. We actually bought some balloons one day and went to a park, and labeled the balloons with feeling words. Like, embarrassment, or disappointment. When he let the balloon go, we had him visualize letting that feeling go.

    Kids don’t really have the cognitive capability for working through how they feel, so sometimes giving them a physical representation of letting it go helps.

Leave a Reply Cancel reply