"When it's all said and done, you don't really find any obvious physical reasons," said Farrell, a gastroenterologist and chief of staff at Cincinnati Children's.

Of all the stresses kids have, Farrell said, the recent emphasis on proficiency testing drives stress levels up even more.

"Kids start having complaints before and during the testing," he said. "I don't know what the answer is. We can't do away with testing. Somehow, some kids are just taking this too much to heart and they're getting physically ill."

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In Farrell's 25 years at Children's, his anecdotal experience shows the rates of stress-related physical symptoms increasing.

His advice to parents:

• Talk to your kids. Let them tell you what they're feeling.

• Be alert for complaints about headaches, stomachaches and nonspecific complaints such as their arm or leg pains.

• Identify if complaints develop into a classic pattern of occurring only Monday through Friday, or always in the morning before school.

• In the beginning, treat the child's symptoms to reassure yourself. But if a pattern develops, you know it doesn't last forever and the child always get better, take a more low-key approach. Try to get at the root cause and help your child figure out ways to cope.

E-mail ckranz@enquirer.com