Pediatric irritable bowel syndrome (IBS) has become increasingly common over the past two decades, and it can be very troubling for both the child and their parents. About 20% of children between the ages of 4 and 18 have IBS. IBS is associated with reduced quality of life, school absences, and psychological challenges.
Most research on therapeutic treatment for IBS is done in adults, which makes treating kids with IBS difficult. Keep reading to find out what experts know about IBS in children.
What is irritable bowel syndrome?
Irritable bowel syndrome (IBS) is a term used to identify a group of digestive symptoms that occur without any physical signs of damage or disease to the digestive system. Symptoms include abdominal pain, bloating, and changes in bowel movements. Children with IBS may alternate between constipation and diarrhea.
IBS is classified as a functional gastrointestinal (GI disorder). Functional GI disorders occur when there is a problem in the way that the brain and gut work together. These disorders are also called disorders of gut-brain interactions. These problems can cause a child’s gut to be more sensitive, leading to abdominal pain, constipation, diarrhea, or both.
Different types of IBS in children
Researchers have determined four different types of pediatric IBS. Each subtype of IBS has different bowel movement patterns and symptoms. Identifying which type of IBS your child has can help the doctor determine which type of treatment will work best. Keeping a log or journal of your child’s symptoms and bowel habits can help you and the doctor determine what type of IBS your child has.
The four types:
- IBS with constipation (IBS-C) - more than 25% of stools are hard and lumpy
- IBS with diarrhea (IBS-D) - more than 25% of stools are loose and watery
- IBS with mixed bowel habits (IBS-M) - more than 25% of stools are loose and watery and more than 25% of stools are hard and lumpy
- IBS subtype (IBS-U) - less than 25% of stools are hard or lumpy, and less than 25% of stools are loose or watery.
Who is at risk for developing IBS?
Studies have shown that both genetic and environmental factors play a role in the development of pediatric IBS. Some genes may increase the risk for IBS, so if someone in your family has it, your child may be more likely to have it, too.
Children who have had bacterial infections of the GI tract are more likely to develop IBS. Since IBS is a disorder caused by a dysfunction in communication between the brain and the gut, children with emotional difficulties such as stress, depression, and anxiety are more at risk for IBS. Things that cause pain or inflammation that occurs during infancy can increase the risk for IBS, including allergies, infections, or surgery.
Symptoms to look for
The most common symptoms of IBS in children are pain in the abdomen, mostly associated with having a bowel movement, and changes in bowel movement patterns (diarrhea, constipation, mixed) depending on what type of IBS the child has.
Other symptoms include bloating, mucus in the stool, and the child may feel as if they have not completely emptied their bowel.
Diagnosing pediatric IBS
Your child’s doctor, typically a pediatric gastroenterologist, will conduct a thorough medical history, physical exam, and may order tests to rule out other damage or disease to the digestive system. The doctor will want to make sure that there is no other cause for your child’s GI symptoms.
The doctor will also review your child’s symptoms, bowel patterns, and habits, so it may be helpful to keep a journal or log of your child’s symptoms.
If your child has had abdominal pain for more than 4 days, pain when having a bowel movement, and changes in their bowel movement patterns, the doctor may diagnose him or her with pediatric IBS.
Your child’s doctor may also diagnose IBS if your child’s GI symptoms have persisted for more than 2 months, and there is no other physical explanation for the symptoms.
Treatment therapies for kids with IBS
Irritable bowel syndrome in kids is treated through a variety of ways. There is no standard treatment for every child, and the doctor will help you determine which treatment is best for your child.
Dietary changes are often recommended for children with IBS, and your doctor may recommend adding a probiotic supplement to your child’s diet. Some studies have shown small doses of probiotics to reduce abdominal pain in kids with IBS, particularly in those who suffer from diarrhea more often.
A dietitian can help you plan a well-balanced diet that suits your child’s needs and preferences. He or she can also help you track what foods may be triggering your child’s IBS symptoms.
For kids with mental health issues such as stress, depression, or anxiety, counseling or cognitive-behavioral therapy might help improve IBS symptoms.
Sometimes medication is recommended to help with constipation and other IBS symptoms.
Nutrition recommendations for IBS in kids
In the past, low-FODMAP diets have been used to treat IBS in both children and adults. This approach to treatment was widely used with minimal research to support its effectiveness. However, recent research suggests that a low-FODMAP diet may help alleviate or decrease symptoms of IBS in children and adolescents.
FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are short‐chained carbohydrates that are poorly digested by the GI tract. This often causes gas, bloating, and discomfort due to the increased osmotic activity and excess gas production from the bacterial fermentation process.
In a study conducted in 2020, researchers studied 29 children with IBS to determine how effective a low-FODMAP diet can be as a treatment for IBS. The results showed that a low-FODMAP diet should be considered an effective diet strategy in treating IBS in children. Although there are other studies that support these results, experts believe more research is needed in this area.
There are 3 steps in the FODMAP elimination diet:
- Eliminate high-FODMAP foods from your child's diet for 2 to 6 weeks.
- Once symptoms are reduced or resolved, reintroduce foods one by one to identify which foods are causing IBS symptoms in your child.
- When you have identified the foods that cause your child's symptoms, you can avoid or limit them and allow them to enjoy everything else without worry.
IBS symptoms and causes vary from child to child. Foods that cause symptoms in one child may not be a problem for another. Some common high-FODMAP foods that may cause or worsen IBS symptoms include:
- Dairy-based milk, yogurt and ice cream
- Wheat-based products such as cereal, bread and crackers
- Beans and lentils
- Some vegetables, such as artichokes, asparagus, onions and garlic
- Some fruits, such as apples, cherries, pears and peaches
During the elimination period of the low-FODMAP diet, center your child’s meals around the following foods:
- Eggs and meat
- Certain cheeses such as brie, Camembert, cheddar and feta
- Almond milk
- Grains like rice, quinoa and oats
- Vegetables like eggplant, potatoes, tomatoes, cucumbers and zucchini
- Fruits such as grapes, oranges, strawberries, blueberries and pineapple
You can obtain a full list of high-FODMAP foods from your child’s doctor or a registered dietitian. Working with a registered dietitian can be very helpful in navigating your child’s nutrition needs while treating their IBS symptoms. Childhood and adolescence is a very important time developmentally, and ensuring they get adequate nutrition is crucial.
About 20% of children suffer from irritable bowel syndrome, and it affects many areas of both the child’s and family’s lives. Identifying which type of IBS your child has can help you and your child’s doctor decide the best treatment. Talk with a doctor to find out if your child has IBS and how to best manage their symptoms.
If you are looking for an easy way to implement the Low FODMAP for a family member or yourself, please visit us at ModifyHealth and explore our Monash University certified Low FODMAP diet meal delivery services. Our Low FODMAP meal delivery provides fully prepared Low FODMAP meals right to your doorstep. Our FODMAP trained dietitian team can also provide coaching and support while helping you achieve better health one delicious bite at a time.
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Kristen Carli, RD – Camelback Nutrition & Wellness (AZ)
Cancer/Oncology Nutrition, Culinary Nutrition (whole foods, recipes, etc.), Diabetes, Type 1, Diabetes, Type 2 and insulin resistance, Heart Health/Cardiovascular, Integrative & Functional Nutrition, Maternal Nutrition and/or Lactation, Medical Nutrition Therapy (MNT), Vegetarian Nutrition, Weight Management