What causes GI issues in teens – and how to get them to talk about it
For some students, heading back to school sparks excitement. For others, it's a source of new or worsening gastrointestinal pain. In this week’s MedBlog, Nandini Channabasappa, M.D., discusses why school stress can provoke GI issues and how to treat them.
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Is it just an upset stomach or something more serious? Most teenage patients come to see us because of gastrointestinal (GI) issues such as abdominal pain.

The transition between carefree summers and the start of the fall semester can be stressful, and academic anxiety can provoke stress-related gastrointestinal symptoms – and exacerbate existing physical disorders, such as inflammatory bowel disease.

Functional and physical conditions often share the same symptoms and can be equally debilitating. Sometimes symptoms resolve once a student gets into a new routine or learns to avoid certain foods. But if symptoms linger and start to affect their daily life, it's time to see the doctor.

Part of my role as a pediatric gastroenterologist is to draw out the root cause of a young patient’s GI issues so we can determine the best treatment. But the first step is for parents to get teens to discuss their symptoms, which can sometimes be a challenge.

How can I get my teen to talk about GI issues?

Many teens are eternally embarrassed. About everything. While they might find bathroom humor funny, it's another scenario entirely when it comes to discussing their own bodily functions.

Parents usually know when something is off with their kids. But demanding answers is a surefire way to get them to shut down instead of getting answers. I've found the best way to approach teens about uncomfortable topics is to treat your conversations like a safe zone rather than an inquisition.

Bring up the symptoms in a knowing but discrete way. For example, if a parent notices their teen gets stomach aches only on school days or holes up in the bathroom for an hour after eating ice cream, approach them like this:

"Hey, I am concerned you might be struggling with some stomach issues when we have certain foods, or in certain situations. Let's talk about that."

"Talking about stomach trouble is never fun. But I need to hear from you where it hurts so we can help you feel better."

"I don't want to make you uncomfortable. We can talk privately about where your pain is and what symptoms your having."

When teens hide their symptoms or refuse help, it’s tough not to get frustrated or emotional as a parent. In these cases, I ask parents to remember what it was like to be a teen. They want to be independent, and many don't like to admit they still need their parents.

It might take several tries, but be patient and calm, and most teens will open up in their own time.

What causes digestive problems in teens?

Stress and anxiety

Just like in adults, emotional turmoil in teens can manifest as abdominal pain, diarrhea, and other gastrointestinal symptoms. It can also make an existing gastrointestinal disorder worse. The sensory nerves in the gastrointestinal system are connected to sensory nerves in the brain. When things aren’t going right mentally, that can manifest physically.

Teens are under a lot of stress these days – from school, friends, class schedules, and safety concerns. A 2018 survey by the American Psychology Associations found that over half of teens today are anxious about the possibility of a mass shooting at their school, and one in five worry about it often or constantly.

Social media can also be a major contributor to stress and anxiety. According to a 2018 Pew Research Center survey, 95% of teens 13 to 17 in the U.S. have their own smartphone or access to one, and 45% say they're on devices almost constantly. Gone are the days when kids could escape social stress and anxiety when they left school. Now it follows them everywhere.

Acute and chronic GI conditions

Teens are also susceptible to many of the same physical conditions that affect adults. Following are some of the more common GI concerns in teens.

Acid reflux: Otherwise known as heartburn, this condition arises when some of the stomach contents splash back up into the esophagus. Long-term acid reflux might be gastroesophageal reflux disease (GERD), which can lead to esophageal damage over time. Symptoms can include burning sensation or pain in the chest and abdomen.

Constipation: Frequent or chronic constipation can be debilitating. It can arise from eating less healthy foods, not getting enough exercise, aversion to public toilets (like at school), or feeling as if they don't have time to go to the bathroom during the day. Symptoms can include hard stools, abdominal pain, and irritability.

Food allergies or intolerance: Parents often think of food allergies in relation to respiratory or skin-related symptoms. However, some food allergy reactions manifest as GI pain, diarrhea, vomiting, and other concerning symptoms.