Stress-Related Physical Symptoms in Children by KKH

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Stress-related physical symptoms in children

Is your child’s stress showing up physically?

From tummy aches before tests to headaches during school days, these seemingly unexplained symptoms can turn everyday activities into worry for parents.

In this ‘Ask the Specialist’ Q&A forum, Dr Delphine Koh, Senior Principal Psychologist, Department of Psychological Medicine at KK Women’s and Children’s Hospital (KKH), answers your questions about supporting your children - from managing school anxiety to understanding their physical reactions to emotional stress!

Learn more about stress-related physical symptoms in children

This topic is part of the 12-book collection, The Baby Bear Paediatric Care Series, that blends engaging storytelling with practical medical advice, covering various common childhood conditions in Singapore.

About Dr Delphine Koh

Dr Delphine Koh is a Senior Principal Psychologist at the Department of Psychological Medicine, KK Women’s and Children’s Hospital (KKH).

As a clinical psychologist, Dr Koh provides psychotherapy and support for children, adolescents, and women presenting with a broad range of mental health conditions, from neurodevelopmental disorders to mood and anxiety issues, across hospital and community settings.

She has a particular interest in how emotional and psychological difficulties can appear as physical symptoms in young people, ranging from everyday stress responses to more complex issues, and believes it is best addressed through care that looks at the whole person.

Her clinical and research interests centre on mental health initiatives across various systems levels, with a focus on prevention and early identification, and she is actively involved in programmes that extend mental health support to community and primary care settings.

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Hi, my child does complain about having a headache suddenly, once in awhile. He rates the pain about 8 or 9 on a scale of 10.

How do I assess to see if it is stress related? As we don’t really pile him with alot of work, other than a 30min enrichment practice every day. He is 8 this year.

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Dr Koh, I have a 5yrs 10months old granddaughter. At home she is very bright, speaks well, energetic and creative. She is in K2 and interacts well with her group of classmates and are very close to 3-4 of them. However, when she is required to perform social functions eg addressing Teachers/Uncles/Aunties (she is familiar with them), presenting show&tell in class, participating at group level among strangers etc., basically any social events, she clamps up and refuses to do or say anything. She also shows little interest to learn from her parents/grandparents and prefers to do things on her own, some acquired through watching video shows. What can you suggest we do to help her as she starts P1 in 2027.

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If conclude stress induced headache, how best can l alleviate the immediate symptom?

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Child is having symptom or headache, self harm as a coping mechanism. How to differentiate between stress and depressed?

If stressor if remove, but future met with another stressor, will the symptom manifest again?

How do decide whether psychologist intervene is needed?

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Answer by Dr Delphine Koh

Headaches rating eight or nine out of 10 in a child are worth taking seriously, regardless of the cause. I would recommend bringing him to see a doctor first to rule out any underlying medical reasons before attributing it to stress.

That said, to get a better picture, it would help to track a few things when the headaches occur: what he was doing beforehand, how long they last, where exactly the pain is, and whether anything makes it better or worse. This information will also be useful for the doctor.

In considering if there are stressors in a child’s life, do note that stress does not always come from academic load alone. Social dynamics at school or in the family, screen time, sleep quality, and even hydration can all play a role.

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Answer by Dr Delphine Koh

What you have described is not uncommon in young children that age. However, since she is starting Primary One in 2027, it is worth gently building her confidence now rather than waiting.

Children may appear confident and comfortable with familiar people, but shy and withdrawn when outside their comfort zone, in more formal or performance-based situations.

She is not avoiding people, she is avoiding the perception that she has to perform for others or that she might be evaluated.

Her preference to learn independently and do things on her own appears to fit with this picture, where she prefers to master things privately. That is actually a sign of a desire for competence, and not defiance or disinterest. The discomfort with performing may be linked to a fear of evaluation from others.

To build her confidence, do encourage gradual exposure to different activities and tasks without the pressure to achieve outcomes. Forcing her to greet or perform tends to backfire and deepens the freeze response. Instead, the goal is to make these situations feel safe and predictable.

Here are some suggestions:

  • At home, when she does “present” something she loves (e.g. a drawing, a toy, a story) to family members, celebrate the effort and attempt, not the perfection.
  • Similarly, if she does participate in activities outside the home, even if it were quiet participation, affirm her bravery for attendance and recount with her the enjoyable aspects of participation in the activity.
  • For greetings with familiar adults, rather than prompting her in the moment, try briefing her before she sees the person. E.g. “We’re going to see Auntie Lily at her house for the Christmas gathering. You can wave to her or say “hello aunty” when you’re ready". This gives her a script and removes the surprise. Many children like her do much better when they know what is expected ahead of time.
  • For show-and-tell or class presentations, speak with her teacher beforehand for accommodations. Check if the teacher can allow her to present to just one friend first, or even to a soft toy, before doing it in front of the class. Small accommodations like this can make a big difference.

Most children with this profile do well once they settle into a new environment like primary school, especially after the first few months when routines become familiar.

However, if she is still not interacting with teachers or non-compliant with teachers’ instructions by mid-Primary One, or shows physical symptoms like stomachaches or crying before school regularly, it would be worth consulting a child psychologist or child psychiatrist.

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Answer by Dr Delphine Koh

Indeed, headaches are one of the most common symptoms of stress.

However, it will still be important to check with a doctor first to exclude any medical reasons before attributing it to stress.

Although over the counter pain medication may be helpful in the short term, do seek medical evaluation if your headaches persist frequently, disrupt your daily life, require overuse of pain medication, or change in pattern over time.

With stress induced headaches, consider using relaxation strategies to try to alleviate the symptom. These can include taking a warm shower to relax neck and shoulder muscles, taking slow, deep breaths, or visualising a calming colour or image.

Distraction by engaging in fun or everyday activities, rather than focusing on the headache can also be helpful.

It is also important that our physical needs and environment are attended to. Ensure that you have had enough sleep and are adequately hydrated.

You may also want to consider dimming the lights and stepping away from screens whilst waiting for the headache to subside.

Do also consider what stressors you might be facing in your daily life and how these stressors can be addressed. Speak to a trusted friend or seek professional help if stressors are overwhelming.

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Answer by Dr Delphine Koh

It seems your child is having a difficult time.

The differentiation between stress and clinical depression: Stress is typically an acute reaction to an external pressure or identifiable trigger that subsides once the demand or stressor is resolved, whereas clinical depression is a persistent, pervasive mood disorder characterised by pervasive sadness, anhedonia (loss of pleasure in normal activities), worthlessness, and disrupted sleep or appetite that persists even when external pressures are absent.

In clinical depression, these symptoms last over a prolonged period, and can impair one’s daily functioning.

However, do note that an individual under unmanaged chronic stress can become clinically depressed. Hence, it is important to address persistent stress issues, rather than ignoring or avoiding symptoms.

Our mind and bodies are intricately connected, and emotions are often expressed physically. Hence, it is highly possible and common that stress symptoms can manifest again when future stressors arise.

It is more important to recognise the symptoms as stress related and develop skills to manage when stressors arise.

As a parent, it might be tempting to jump in and solve the problem for your child. However, this may not help your child develop problem solving skills. Instead, guide them to explore different ways to help them solve problems or to manage their emotions when challenging situations arise.

Professional psychological intervention is strongly indicated when self-harm is used as a coping mechanism, when distress or symptoms consistently interfere with daily functioning, school performance, or relationships, or when coping strategies feel unmanageable regardless of whether specific stressors are present.

Watch this video: https://youtu.be/-2R7AR0pJTY and access My Coping Toolbox at www.kkh.com.sg/my-coping-toolbox for more tips on coping with stress-related symptoms.

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Hi there, not sure if my kid’s symptoms has anything to do with stress. Since he was 1 year plus, he would wakes up screaming in the middle of the night, of pain in his joints or his limbs. This could happens consecutively few nights in a row and seems to happens once every 1-2 months. The only way to relief his pain is to constantly massage the areas the pain occurred. The puzzling thing is his pain seems to travel from days to days. Locations not always the same spots, but definitely somewhere in the limbs. What is wrong with him? I have brought him to see GPs and none could give me an answer. This is disrupting the sleep quality for both my kid and myself. I often have to stay up throughout the night to give him massages so that he can try to go back to sleep.

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Dr Koh
Thank you for your very detailed and useful reply. I will pass it on to the parents and we will certainly try
the suggested actions by you.

Once again, thank you.

Warm Regards
Connie

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Child is 8 and has sleep terrors which occur usually about 1.5 hours after bedtime. Sometimes it will also result in shouting, violent kicking and thrashing around with tears in eyes. There is no recollection of the event upon awakening. Unsure if this is stress induced, or too much daytime stimulation. Does this warrant further evaluation or are there any aids to minimize this from occurring? Thank you.

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Answer by Dr Delphine Koh

The symptoms are less likely to be primarily due to stress (somatisation) given the young age.

If the pain in the limbs and joints only happens at night and resolves spontaneously by morning, this could be growing pains.

However, if the pain is persistent, or causing significant dysfunction, we would advise bringing your child to a medical professional for an evaluation.

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Answer by Dr Delphine Koh

Children are more likely to experience sleep terrors than adults. During an episode, they may sit up, cry, scream, or thrash about, and may also experience an increased heart rate or shortness of breath. Episodes can last up to an hour, after which the child usually falls back to sleep on their own.

As a parent, it can be distressing to witness, and attempts to calm the child down may actually make them more agitated. It is often best to simply ensure they are safe and wait for the episode to pass.

Sleep terrors do not have a single cause, but a range of physical and emotional factors can act as triggers.

On the physical side, these include fever, sleep deprivation, and obstructive sleep apnoea. Emotionally, stress and anxiety experienced during the day may also play a role.

Keeping a log of daytime events alongside occurrences of sleep terrors can help identify possible triggers over time.

Further evaluation would be helpful if the episodes occur frequently (e.g. several times a week over a sustained period), if the child’s sleep quality is affected and they appear listless during the day, or if injuries from sleep terrors are a recurring concern.

Management will depend on the contributing factors identified and the overall impact on the child.

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My teenage daughter started self talk and now we can’t get her out of it. Tried many many things. Favourite food, toys, activities. No interest. She even lost connection with friends. Won’t talk to them When they come over. What can I do?

She is a special child.

Is this a coping mechanism for disappointments in life or a ‘dopamine imbalance’, as someone advised me. What does dopamine imbalance mean?

Help please. :folded_hands:

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Answer by Dr Delphine Koh

It sounds like you have observed the self-talk as a new behaviour that is concerning because you have not been able to get her to stop.

Depending on the function of self-talk, itself isn’t always a concern as many people do use it as a coping strategy.

However, it is hard to understand from the description why your daughter may have started self-talking. It may serve the function of self-soothing, problem solving, sensory stimulation, or be ruminative and obsessive in nature.

Aside from her increase in self-talk, are there observations of changes in her behaviours in the different areas of her life?

These changes may be because of the increase in self-talk or for reasons that appear unrelated to self-talk.

If the change in behaviour is a noticeable change from before, and has lasted for more than two weeks, it will be worthwhile going for an assessment with a psychiatrist or psychologist who has experience working with children and adolescents. They can assess what’s causing the withdrawal and whether there’s an underlying condition that needs support.

A “dopamine imbalance” is a lay term sometimes used to describe conditions where the brain’s reward system works differently. It’s not a formal diagnosis on its own, so I’d be cautious about taking that framing too literally without a proper assessment.

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Thank you so much for your useful reply. A little bit reassuring.