Children frequently complain of tummy aches.  Where as you and I say we have a headache or a sore throat when we are not feeling well, children often point to their tummy as the site of discomfort.  Most parents learn that a one time complaint of a tummy ache is usually nothing to be worried about and give their child a glass of water and distract their child with a story or a hug. The discomfort passes without any further intervention.

But what happens when that tummy ache doesn’t go away?  What is a parent to think when the tummy aches seem to occur more and more frequently? Or seems to be associated with school starting in the fall?  Is this really a stomachache or is something else actually to blame? Are they attention seeking? Is it school avoidance? Are they being bullied at school?   These worries can run thru any parents head when their child’s complaints become more and more frequent.

From personal experience working in the Emergency Department at Cook Childrens, for children under 1 year old without fever who present with chief complaint of abdominal pain, the most common diagnosis is actually constipation.  A recent study published in the Journal of Pediatrics looked at almost 10,000 ED visits to a children’s hospital, focusing on children with the chief complaint of abdominal pain found the same results. Constipation is the most common diagnosis for childhood abdominal pain.

Many parents argue that their child could not be constipated because their child has a bowel movement daily.  However, constipation as a medical term, means not going enough to empty the bowels, going once may not be frequently enough.  You can go 3-4 times a day and still be constipated if you still have bowels filled with stool. These parents often don’t believe me that this is the real cause of the problem until the X-ray shows their child’s bowels filled with stool.

So why does this sort of tummy ache seems to get worse once school starts? Well, we all live a hectic lifestyle and children are no different.  How often are we are running late to get to school and kids don’t have time to use the bathroom before leaving the house?  They may have the urge once at school, but most children, and most adults, do not want to use toilets at school or other public places.  They learn if they hold the stool past the urge, they can continue their normal routine without having to use the toilet at school.  Eventually, the incomplete emptying of the bowels leads to constipation resulting in tummy aches.   The pain associated with constipation commonly occurs during the following times: when they first wake up, when they eat, at night when they are relaxed and more often on school days than during weekends.

So what symptoms should cause a parent or guardian to contact their child’s medical provider sooner?  If your child has one of the following symptoms: increasing pain over a 48 hour period, fever, severe vomiting and diarrhea, diarrhea with blood or pain that is localized to the right lower abdomen. You should seek advice from your medical provider as soon as possible.  These symptoms are not characteristic of a child with constipation.

 What can you do if you think your child is suffering from constipation? 

  • Increase fiber in your child’s diet.  ex. Apples and pears with the skin still on.
  • Decrease the amount of junk food in their diet
  • Watch the amount of milk your child drinks in a day.  They only need two glasses a day of lowfat dairy.  they can consume dairy in other forms such as yogurt.
  • Get up 30 minutes earlier in the morning.  Feed them a little breakfast then have them sit on the toilet for 10-20 minutes.  Its not a punishment.  It’s meant to give your child a chance to go before school.  Once they have had a bowel movement the remaining time of the 20 mins is theirs to do as they please. 
  • Over-the-counter laxatives and stool softeners.  Talk with your medical provider on their preference and dose they want you to start at. 

Frank Sloan, M.D., is an emergency physician at Cook Children’s Medical Center.

Related Links

  • Constipation Instruction Sheet
  • Fiber and Your Child
  • Soiling (Encopresis)
  • Constipation
  • How Can I Tell if My Baby Is Constipated?