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IBS in Children: Symptoms, Diagnosis, and Management

By 5th October 2024October 10th, 2024IBS
child with ibs

IBS is a functional digestive condition which can impact people of any age, including children and adolescents. With some studies estimating that IBS can impact up to 15% of children in the Western world.

Not only can these conditions lead to ongoing pain and discomfort but also an altered relationship with food as well as increased levels of anxiety and depression.

This article will discuss the causes of IBS in children, how it can be diagnosed as well as ongoing management and treatment.

Understanding IBS in Children

IBS is defined as a functional gastrointestinal disorder (FGID). This refers to the fact that symptoms are present without any structural or known biological changes in the gut.

As in adults, IBS in children is often diagnosed once other causes of the symptoms have been excluded.

These other causes that need to be excluded include:

  • Inflammatory bowel disease
  • Coeliac disease
  • Bowel cancer

In the absence of these known conditions, specific symptoms and frequency of these symptoms need to be met for a diagnosis of IBS.

These include:

Abdominal discomfort or pain associated with 2 or more of the following (present at least 25% of the time):

  • Improved after defecation
  • Onset of symptoms associated with a change in stool frequency
  • Onset associated with a change in stool form alternating between diarrhoea and constipation

As mentioned these symptoms are present along with no evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the child’s symptoms.

This differs from the diagnosis of IBS in adults, where symptoms need to be present for 3 months for an IBS diagnosis, rather than 2 months as in children.

Additionally, prior to 1995, IBS was not as well recognised in children, instead, it was described as RAP (recurrent abdominal pain). [1]

Symptoms and Causes of IBS in Children

The symptoms and causes of IBS in children and not too dissimilar to that of adults. These can be varied with several risk factors often combining and leading to the onset of IBS symptoms.

Common Symptoms

The most common IBS symptoms are:

  • Abdominal pain
  • Bloating
  • Diarrhoea
  • Constipation

While not required for a diagnosis of IBS, other symptoms are very common in children with IBS.

These include:

  • Food intolerances
  • Spending a long time on the toilet
  • Increase gas and wind
  • Fatigue

Causes and Triggers

As with adults, there is not a single risk factor that leads to all cases of IBS.

Instead, there are known risk factors that often combine which may then lead to the onset of IBS symptoms.

These factors can include:

  • Other family member with IBS
  • Stressful life events
  • Genetics
  • Infection
  • Low-grade inflammation
  • Food allergies
  • Gut bacteria imbalances/overgrowths
  • Altered gut-motility
  • Visceral hypersensitivity (increased nerve sensitivity)
  • Gut-brain interaction

One of the most common causes is an infection or case of food poisoning. This can be described as post-infectious IBS which results from an ongoing, yet low-level inflammatory response following the acute stage of the infection. These cases of food poisoning can include Salmonella or Campylobacter infection.

Studies have found that up to 25% of those with IBS had an infection that triggered the onset of their symptoms.

Further findings have been reported which provide further indication into contributing factors. This can include altered serotonin signalling, increased intestinal permeability and low-grade inflammation in the guts of those with IBS.

Additionally, lower levels of beneficial short-chain fatty acids have also be reported in the digestive tracts of children with IBS. This may be related to alterations in the gut microbiome, with reductions in the organisms that produce this beneficial gut compound. [2]

Diagnosing and Managing IBS in Children

The diagnosis and management of IBS in children are not entirely dissimilar to that in adults, however, there are some key differences between both.

Diagnosing IBS

The diagnosis of IBS can be made by a doctor or gastroenterologist. This is provided once other causes of the symptoms have been excluded.

These other causes are often tested for via specific tests that include tests for:

  • Lactose intolerance
  • Coeliac disease
  • Inflammation (ERC, c-reactive protein, calprotectin)
  • Liver function tests (which can be altered in IBD)
  • Full blood count (to assess for anaemia, a sign of blood loss, possibly due to IBD)
  • Stool samples, to assess for an infection

If these tests are not conclusive, an endoscopy or colonoscopy may be considered by a paediatric gastroenterologist. However, due to the invasive nature of these procedures, these are generally only considered in difficult cases.

Further to this, in children, a set of symptoms are referred to as red flags. These may require further examination or investigation:

  • Night-time pain or diarrhoea
  • Recurrent unexplained fever
  • Recurrent or worsening rectal bleeding
  • Joint pains
  • History of weight loss and poor growth
  • Family history of inflammatory bowel disease
  • Persistence of severe vomiting or diarrhoea
  • Unexplained pallor
  • Stools that may be difficult to flush away
  • Delay in onset or progression of puberty [3]

Management and Treatment Strategies

The aim of supporting a child with IBS is to improve quality of life. This can be via both the introduction of symptom management techniques as well as treatments.

As with adults, these techniques may need to be multidisciplinary, involving support from various specialists.

This can involve:

  • Dietary support
  • Therapeutic supplements
  • Emotional support (gut-brain support)

Dietary support to identify and remove trigger foods. As in adults, a Low FODMAP diet has been shown to help reduce symptoms of IBS and improve quality of life. Due to the complexity of this diet, it is over best implemented with the support of a nutrition practitioner.

Supplements have also been found to be helpful when treating children with IBS.

These include:

  • Probiotics (VSL3, L Rhamnosus GG)
  • Prebiotics (PHGG)
  • Peppermint oil [4]

Supporting a Child with IBS

For the most part, supporting a child with IBS can be similar to supporting an adult. However, there may be more care and attention to certain areas of the treatment plan.

This may involve more in-depth emotional and social support.

Emotional Support

It can also be to reduce stress, explaining to the child and family, that even though symptoms are present, a more serious underlying condition has not been found.

Various from of psychological support are also considered to support the gut-brain connection to manage stress and improve quality of life.

These include:

  • Gut-directed hypnotherapy
  • CBT
  • Yoga
  • Acupuncture [5]

School and Social Support

A key part of supporting a child with IBS is having open conversations in an attempt to normalise the challenges of IBS.

The aim of this is to reduce any stress and social stigma from any dietary modifications or altered bowel patterns.

At first, for many children, having to discuss their bowel patterns is embarrassing but overcoming these hurdles may also improve outcomes.

This can involve requesting:

  • appropriate meals from school
  • the child be allowed to leave the classroom as needed to use the toilet

Snacks can also be provided that look similar to the ones classmates and friends have. This can help the child to not feel left out of excluded.

Over the long term, this is also where working to address the underlying causes of the IBS symptoms is also important.

Conclusion

While the causes and diagnostic approach for IBS in children can be similar to that seen in adults, the therapeutic approach does need to be modified.

This can be with ways to explain to the child the nature of their symptoms combined with strategies to help manage any social awkwardness around dietary changes and requiring the toilet.

Working with a registered gut health nutritional therapist can help to navigate this treatment process to resolve symptoms.

Contact us for a free assessment call.

References

 

Sandhu, Bhupinder Kaur, and Siba Prosad Paul. “Irritable bowel syndrome in children: pathogenesis, diagnosis and evidence-based treatment.” World journal of gastroenterology vol. 20,20 (2014): 6013-23. doi:10.3748/wjg.v20.i20.6013

Schwille-Kiuntke J, Enck P, Zendler C, Krieg M, Polster AV, Klosterhalfen S, Autenrieth IB, Zipfel S, Frick JS. Postinfectious irritable bowel syndrome: follow-up of a patient cohort of confirmed cases of bacterial infection with Salmonella or Campylobacter. Neurogastroenterol Motil. 2011 Nov;23(11):e479-88. doi: 10.1111/j.1365-2982.2011.01779.x. Epub 2011 Aug 30. PMID: 21883703.

Sandhu, Bhupinder Kaur, and Siba Prosad Paul. “Irritable bowel syndrome in children: pathogenesis, diagnosis and evidence-based treatment.” World journal of gastroenterology vol. 20,20 (2014): 6013-23. doi:10.3748/wjg.v20.i20.6013

Horvath A, Dziechciarz P, Szajewska H. Systematic review of randomized controlled trials: fiber supplements for abdominal pain-related functional gastrointestinal disorders in childhood. Ann Nutr Metab. 2012;61(2):95-101. doi: 10.1159/000338965. PMID: 22889919.

Adinolfi B, Gava N. Controlled outcome studies of child clinical hypnosis. Acta Biomed. 2013 Sep 1;84(2):94-7. PMID: 24165457.

History

  • Reviewed and updated 5th October 2024 by Martin Cohen