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Spotting IBS in Children

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Do you suspect your child has Irritable Bowel Syndrome (IBS)? It has been reported that 6-14% of the adolescent population have reported IBS symptoms like bloating, gas, diarrhea, or constipation. While these symptoms don’t always mean irritable bowel syndrome (IBS), it’s worth talking to your child’s doctor about your concerns about IBS. Read on to find out more about symptoms, diagnosis, and treatment of IBS in children.

 

Symptoms

Irritable bowel syndrome (IBS) symptoms include bloating, gas, cramping, recurrent abdominal pain, constipation, and/or diarrhea. Symptoms may also play out in different behaviors, which may vary based on age. For instance, younger children may display a decrease in appetite or complain of back pain. Adolescents or teenagers may present with anxiety or depression due to their inability to control IBS symptoms.  They may also not want to go to school or social events due to IBS symptoms like abdominal pain, the urgency for a bowel movement, or diarrhea.

 

Diagnosis 

Children and their families should meet with a Pediatric Gastroenterologist to confirm an IBS diagnosis. Their doctor will likely rule out other conditions like Celiac Disease, Ulcerative Colitis, and Gastroesophageal Reflux Disease (GERD) before arriving at an IBS diagnosis. Diagnosis of irritable bowel syndrome (IBS) is typically made using the Rome IV criteria below:

  • IBS symptoms occur at least 4 days out of the month for more than 2 months
  • Abdominal pain and cramps are associated with one of the following: 
    • Related to a bowel movement
    • Change in frequency and/or form of stool
    • Constipation: abdominal pain does not resolve after a bowel movement

 

Cause

Similar to adults with irritable bowel syndrome (IBS), the cause is unclear. IBS may be related to hypersensitivity in the bowels, stress, bacteria, or motility (i.e. how food moves through the digestive system). 

 

Treatment

There are various treatment options for irritable bowel syndrome (IBS) that take into account the severity of IBS symptoms and impact on quality of life. IBS treatments include medications, dietary changes, and non-dietary therapies. Examples of IBS medications your doctor may recommend are antibiotics, antispasmodics, motility agents, or low-dose antidepressants. Be sure to ask your healthcare provider about any potential side effects, how long your child may need to be on medication for IBS, and what their other options are.

Food and fluids may play an important role in your child’s IBS symptoms. The first thing you should consider is how consistent their meals and fluid intake are. Your doctor may recommend working with a Registered Dietitian if you’re struggling with consistent nutrition or if another dietary approach may be recommended. A dietitian will look at your child’s growth, any feeding difficulties (i.e. picky eating or food refusal), quality of life, the severity of symptoms like constipation or diarrhea, adequate fiber, and fluid intake, and finally, FODMAPs intake. Depending on your child’s age, the Low FODMAP diet may be a viable option. However, just like with adult irritable bowel syndrome (IBS) patients, children should be screened for any disordered eating. Anyone with a current eating disorder or a history of one is not a candidate for the Low FODMAP diet. 

If your healthcare provider thinks that the Low FODMAP diet is a good idea for your child’s IBS, here are a few tips you can try:

  • Simple swaps: An RD can help identify a few foods with high FODMAPs that they are eating consistently and try swapping them out one at a time.
  • Does your child consume a lot of apple juice or milk? Try reducing and replacing with water, as those are both two high FODMAP options. Switching to lactose-free milk is another option. 
  • Try substituting their high FODMAP granola bar with a low FODMAP alternative (GoMacro and Enjoy Life Foods are two good options, as well as the Peanut Butter & Chocolate Energy Bites from Epicured).
  • Swap out blueberries in their cereal with strawberries.
  • Instead of cut-up, green bell peppers try red bell peppers or baby carrots.
  • Once you’ve identified a trigger, change the food in various portion sizes regularly to see if their tolerance changes.

There are also many science-backed non-dietary treatments. These include yoga, gut-directed hypnotherapy, and Cognitive Behavior Therapy (CBT). Your doctor may refer you to a child therapist that uses one of these treatments or something else like guided imagery or talk therapy. Daily physical activity can also help with symptoms and stress relief. Try different games outside or take a family walk. Finally, make sure that your child has a regular bathroom routine, which is especially important for younger children. This may simply look like encouraging them to use the bathroom post-meal or before nap time. 

 

References

Devanarayana, N. M., & Rajindrajith, S. (2018). Irritable bowel syndrome in children: Current knowledge, challenges, and opportunities. World journal of gastroenterology, 24(21), 2211–2235. https://dol.org/10.3748/wjg.v24i21.2211

International Foundation for Gastrointestinal Disorders (IFFGD). (2021, March 30). Irritable bowel syndrome. Irritable Bowel Syndrome. https://aboutkidsgi.org/lower-gi/irritable-bowel-syndrome/. 

Malagelada, J. R., & Malagelada, C. (2018, June 28). Management of irritable bowel syndrome in children. Journal of Pediatrics and Pediatric Medicine. https://www.pediatricsresearchjournal.com/articles/management-of-irritable-bowel-syndrome-in-children.html. 

The Children's Hospital of Philadelphia. (2014, August 24). Irritable bowel syndrome in children. Children's Hospital of Philadelphia. https://www.chop.edu/conditions-diseases/irritable-bowel-syndrome-children. 




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About Author

Liz McMahon, RDN, LDN
Liz McMahon, RDN, LDN

Liz is a Registered Dietitian who focuses on digestive health. She has completed FODMAP training through Monash University and loves seeing the benefit her IBS patients have with this diet! Liz has been in the nutrition field for over 10 years, working at a top hospital in Philadelphia as a Clinical Dietitian for the past 5 years. She also runs her own private practice, Liz McMahon Nutrition, where she provides virtual nutrition counseling to clients with a range of gastrointestinal disorders.

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