<<Disclaimer: Verify this information before applying it to your situation.>> Our almost 3 year old daughter has celiac and I do know that at times she has used the excuse of my tummy hurts to avoid going to bed or picking up toys or a host of other things. I think one should be able to tell whether it's manipulation or not. If Valerie cries, doubles over in pain, and refuses to eat her favorite foods than it is truly real rather than manipulation. I think anyone who is touch with their child will be able to tell the difference. For what it is worth. Faye