It’s a common ailment – particularly around the time your little one is supposed to get ready for school – the illusive tummy ache. Is it real or just a made up reason to avoid going to school?  Knowing your child very well is probably the only way you’re going to know for sure, but you should also take into account how severe the pain appears to be. 

Turns out that a recent study found that constipation is the most common reason for abdominal pain among children going to the emergency room.

Appendicitis is always a concern when someone complains of bad stomach pains but researchers noted that only about 4 percent of the children, who went to the ER with a tummy ache, were diagnosed with appendicitis.

The study, led by Kerry Caperell, MD, of the Department of Pediatrics at the University of Louisville in Kentucky, looked at the outcomes of children who went to the emergency room for abdominal pain.

The researchers investigated the medical records of 9,424 children, aged 1 to 18, who went to the Children's Hospital of Pittsburgh emergency department for abdominal pain during a two-year period.

They found that more than half of the children received multiple diagnoses for their complaints. Appendicitis was less common among younger children, but constipation was commonly diagnosed for all ages.

More than 20 percent of the children were diagnosed with constipation and for kids, ages 5-12 years of age; the diagnosis went up to 25 percent.

Diagnosing causes of abdominal pain in children can often be difficult, especially the younger they are," said Chris Galloway, MD, a dailyRx expert who specializes in emergency medicine.

"Fortunately common causes are still common and constipation is a frequent diagnosis we make in the ER, and can be quite distressing for your child," Dr. Galloway said. "Consult your pediatrician if your child has abdominal pain."

Older children seem to have more serious ailments and were more likely to remain in the hospital and have an operation related to the reason they went to the ER.

The study was published in the journal Pediatrics.

What causes constipation in children? Constipation is common in children and typically is not an indicator of bowel problems late in life, but can be very uncomfortable. If your child has had a painful bowel movement because the stool was hard and difficult to pass, he or she may try to hold their stools. This creates a viscous cycle, where bowel movements are painful, so he holds them in, causing his stools to be even larger and harder, which causes more pain when it finally does pass. Many parents mistake the behaviors that children develop to hold in stool as straining to have a bowel movement, but they are usually stiffening their muscles or fidgeting as an attempt to hold their stool in and avoid a painful bowel movement.

Children with special needs, such as spina bifida, Down syndrome, mental retardation and cerebral palsy, often experience constipation that may be related to certain medications.

Infants that are constipated should be evaluated by their pediatrician.

Making changes in your child’s diet can often treat constipation. Fiber is important for good bowel movements in children as well as adults. The usual recommendation is that children should have 5-6 grams of fiber plus their age in years each day. So a 4 year old should have 9-10 grams of fiber each day.

Sometimes dairy products can cause constipation. Cow’s milk, yogurt and cheese can cause constipation and how much is too much is something that parents have to experiment with. Some children can drink a lot of milk and never get constipated, while others don’t have to drink much at all before they end up with a bad tummy ache. For children that drink a lot of milk, soy milk is a good alternative, as it is usually much less constipating than cow's milk.

Vegetables that are high in fiber include beans, especially baked, kidney, navy, pinto and lima beans, sweet potatoes, peas, turnip greens and raw tomatoes. Other foods that are good for children with constipation include vegetable soups (lots of fiber and added fluid), and popcorn. Extra bran can also be helpful, including bran cereals, bran muffins, shredded wheat, graham crackers, and whole wheat bread.

It takes awhile for dietary changes to help manage constipation; in the meantime there are some common medications that can be administered. Be sure and only give the recommended pediatric doses. A child’s age can play a role in which medications your pediatrician will recommend so check with him or her first before trying any over-the counter medicines.