Why Does My Child Feel Sick Before Exams or Big Days at School?

Understanding the Gut–Brain Link in Teen Anxiety

One of the most common concerns parents bring to clinic is this:

Their child is bright and capable. There is no underlying medical illness. Yet before exams, presentations, or even certain school mornings, they feel nauseous, shaky, short of breath, or as if there is a lump in their throat. In some cases, they may even vomit.

Understandably, parents begin to worry:

Is something physically wrong?

In most cases, the answer is no. What you are seeing is the gut–brain connection in action.

The Alarm System in the Teenage Brain

When a young person anticipates an exam or stressful school situation, their brain does not simply see a test paper or classroom. It may interpret the situation as a threat.

Thoughts such as:

• What if I fail?
• What if I panic?
• What if I embarrass myself?

can activate the brain’s alarm centre, known as the amygdala.

The amygdala cannot distinguish between a genuine physical threat and a perceived social or performance threat. Whether it is a tiger or a maths exam, the body responds in the same way by activating the fight-or-flight response.

This survival system has existed for thousands of years. It prepares the body to deal with danger. The difficulty is that an exam or stressful school day may feel overwhelming, but it is not dangerous.

Why Anxiety Shows Up in the Stomach

The vagus nerve is the primary communication pathway between the brain and the digestive system. It runs from the brainstem through the throat, heart and lungs, and into the stomach and intestines.

When the alarm system switches on, several physiological changes occur:

• Blood flow shifts away from digestion
• The stomach tightens
• Breathing becomes faster or shallower
• Throat muscles tense

This can lead to nausea, a lump-in-the-throat sensation, air hunger, lightheadedness, and in some cases vomiting.

Vomiting during intense anxiety is not weakness or loss of control. It is the nervous system attempting to discharge stress. Once this has happened before an exam or school day, the brain can begin to associate school-related stress with feeling sick. The pattern then reinforces itself.

The Anxiety Loop

For many teenagers, the cycle becomes automatic.

A stressful event is approaching.
They begin to worry about how they might feel.
The body’s alarm system activates.
Nausea or throat tightness appears.
They think, “It’s happening again.”
The alarm intensifies.

The sensations are uncomfortable, but they are not dangerous. However, the brain interprets them as further evidence of threat, and the loop continues.

Why It Feels So Intense in Adolescence

During adolescence, the emotional centres of the brain are highly active, while the logical and regulating areas are still developing. This means anxiety can feel faster, stronger, and more overwhelming than it might in adulthood.

If we pause for a moment and place ourselves back in our teenage years, most of us can remember how intense emotions felt at that age. A small setback could feel enormous. A single moment of embarrassment could replay for days. The body reacted quickly, and the feelings were often bigger than the situation itself.

Teenagers are not overreacting. Their nervous systems are still learning how to regulate under pressure. When we understand this, it becomes easier to respond with patience rather than frustration.

The Goal Is Not to Remove Anxiety

A small amount of anxiety before exams or important school events is normal and can even improve focus and performance.

The goal is not to eliminate anxiety entirely. The goal is to teach the brain that the situation is uncomfortable but safe.

When the nervous system learns safety, physical symptoms begin to reduce. Breathing steadies. The throat relaxes. The stomach settles. Confidence builds not because anxiety disappears completely, but because the young person learns they can manage it.

When Should You Seek Support?

It may be helpful to seek support if your child is:

• Vomiting frequently before school
• Avoiding exams or refusing school
• Experiencing panic attacks
• Becoming highly distressed or withdrawn

Early intervention prevents patterns from becoming entrenched. The sooner the nervous system is retrained, the easier it is to shift.

What Schools Can Do to Support Exam and School Anxiety

Schools cannot remove academic pressure entirely, but they can reduce unnecessary nervous system overload.

Simple, evidence-informed approaches can make a significant difference.

Normalising anxiety is a powerful first step. When teachers acknowledge that it is normal to feel nervous before exams or presentations, shame reduces and students feel less alone.

Teaching brief regulation strategies can also help. Even three to five minutes of slow breathing, grounding exercises, or steady pacing before an exam begins can lower sympathetic activation. Longer exhales stimulate the vagus nerve, which supports the body’s calming system. This is physiology, not simply mindset.

Language matters as well. Statements that frame exams as life-defining can unintentionally amplify threat perception. Framing exams as one opportunity to demonstrate learning helps reduce catastrophic thinking.

Mock exams reduce novelty and unpredictability, both of which heighten anxiety. Familiarity builds safety.

Allowing short reset moments, such as a brief toilet break, a sip of water, or a one-minute breathing pause, can prevent escalation.

For local schools, I provide brochures and information materials explaining the gut–brain connection and practical tools students can use immediately. Workshops or parent evenings can also support understanding during high-pressure periods such as GCSEs and A-Levels.

What Parents Can Do at Home

Parents play a central role in nervous system regulation, often without realising it.

When a child says, “I feel sick. I can’t do this,” the natural instinct is to reassure verbally. However, regulation is often more effective than reasoning in the moment. Slowing breathing together for one or two minutes can calm the system more effectively than lengthy discussion.

It is also important to avoid over-rescuing. While it is painful to see a child distressed, removing every challenging situation can unintentionally reinforce the belief that they cannot cope. A balanced message is more helpful: you might feel anxious, and you can still manage.

Keeping perspective visible matters. One exam does not define intelligence. One result does not determine the future. Effort, resilience, and growth matter more than a single outcome.

Sleep and routine are equally important. Sleep deprivation increases sympathetic activation and makes anxiety more likely. Consistent routines support nervous system stability.

Parents should also be mindful of their own stress levels. Children are highly sensitive to parental anxiety. Calm is contagious, and so is stress.

What I Do in Therapy

When a young person presents with nausea, throat tightness, or panic around exams or school stress, our work is structured and practical. We focus on three key areas:

1. Build Understanding
   • Explain how the fight-or-flight system works
   • Clarify the role of the vagus nerve in the gut and breathing
   • Normalise symptoms such as nausea, throat tightness, and air hunger

When a young person understands what is happening in their body, fear reduces. Clarity lowers alarm.

2. Strengthen Nervous System Regulation
   • Practise slow, low breathing to stimulate the body’s calming system
   • Teach throat relaxation techniques to ease the “lump” sensation
   • Introduce structured exposure to exam-like situations in manageable steps

These tools strengthen the nervous system’s “calm brake” and build real confidence.

3. Retrain the Pattern
   • Identify catastrophic thinking
   • Reduce fear of physical symptoms
   • Gradually re-associate exams and school situations with challenge rather than danger

The aim is not to remove anxiety completely. The aim is for a young person to be able to say, “I can feel anxious and still function.”

Teenagers often respond quickly when the approach is structured, evidence-informed, and practical.

A Final Word

If your child feels sick before exams or stressful school days, their body is not broken. Their nervous system is reacting to perceived threat.

With the right understanding and tools, that system can be retrained. Young people are often far more capable of change than we expect.

If you would like support for exam anxiety, school-related stress, or gut-focused anxiety symptoms, you can learn more about my Teen Gut–Mind Programme or book an initial session via Teen Gut-Mind Program