Irritable bowel syndrome (IBS) is a chronic digestive disease that can also occur in children. If parents are affected by IBS, the risk for their children increases. It is believed that an interplay of genes, intestinal flora, and social circumstances is responsible for this. IBS is particularly challenging in children because they communicate the symptoms differently. This makes it particularly difficult to differentiate from similar, sometimes dangerous, diseases such as Crohn's disease or ulcerative colitis.
1. Are children affected by IBS?
IBS can occur at any age, but it is particularly difficult to diagnose in children as they have difficulty describing and localizing their symptoms if they are under the age of twelve years. Parents are required to observe their child and to understand and describe their complaints. A diagnosis can not be made in children under four years of age because the digestive tract and nervous system are not yet fully developed.
2. What are IBS symptoms in children?
The most common symptoms with children are:
- Upper abdominal pain
- Loss of appetite
- Mucous in the stool
In many sufferers, the symptoms only begin to creep in and are often located in the stomach at the beginning. Different symptoms can occur in each affected person, which is why those affected are divided into so-called symptom types (diarrhea, constipation, mixed, and pain types). Children over four years of age with IBS have in common that they have sensations of discomfort or pain in the abdomen in most cases. If there is pain, it often gets better with bowel movements. In addition, there is often a change in bowel movements with changed shape, color, and frequency.
3. What are warning signs in children?
If a child has symptoms from the following list, it is suspected that it is not IBS but other causes that are responsible for the symptoms:
- Pain below the navel
- Heavy diarrhea
- Visible blood in the stool
- Unwanted weight loss
- Growth and development disorders
- Problems with performance
- Inflammatory bowel diseases in the family (e.g. Crohn's disease or ulcerative colitis)
4. Why is IBS a special challenge in children?
Children with IBS often feel bad. With diarrhea-type IBS, children often realize too late that they have to go to the toilet. For this reason, the affected children are often uncomfortable and embarrassed. As a result, they withdraw and do not want to meet friends or go to school. This often also results in psychological stress.
Generally children with IBS develop and grow normally. In some cases, affected children consciously eat less to avoid the pain that occurs during digestion. This can lead to weight loss.
5. How common is IBS?
It isn’t easy to estimate the frequency of IBS in children. It is difficult to differentiate the syndrome in children from other diseases of the gastrointestinal tract, since many children cannot yet describe and localize their symptoms exactly.
In the Robert Koch Institute's long-term KIGGS study, parents of 3- to 10-year-old children stated that they complain most frequently (69 percent) of abdominal pain. The 11- to 17-year-olds surveyed stated that their pain occurs in the abdomen in 60 percent of the cases. It is estimated that around 20 percent of these children with abdominal pain are affected by IBS.
6. What causes IBS in children?
The causes of IBS have not yet been discovered. Most often, it is assumed that the intestine shows changed motility and is more sensitive than a healthy intestine. This causes the intestine to react more strongly to food or stress, which can lead to the typical symptoms. Most of the time the symptoms begin to creep in, often in teenage or young adulthood. However, they can also appear spontaneously, such as after a gastrointestinal infection (post-infectious IBS) or taking medication (especially antibiotics).
To date, no specific genes are known to cause IBS. However, the risk of IBS is increased in children whose parents are affected. An interplay of genetic and social factors is probably responsible for this.
Contrary to popular belief, the lack of an organic cause does not necessarily mean that the cause is psychological. However, IBS often occurs together with psychological stress and strain. It is difficult to determine whether these are the cause of the disease or only arise as a result.
7. How is IBS diagnosed in children?
If the symptoms appear about once a week for three months, a pediatrician should be consulted. IBS symptoms are also typical of many other diseases of the intestine, such as infant colic, constipation, or heartburn (gastroesophageal reflux). Therefore, all organic causes for the complaints must be excluded.
The pediatrician is guided here by the diagnostic standards of the S3 guideline and the Rome III/IV criteria. This ensures that there are no organic causes for the complaints. Anatomical peculiarities of the intestine, malignant tumors, and metabolic diseases (e.g. thyroid disease) must be excluded.
The following are used as the basis for the diagnosis:
- Physical examination
- Blood test
- Urine test
- Stool test
If you suspect lactose or fructose intolerance, you can also carry out hydrogen breath tests.
8. What treatments are there for children with IBS?
Since there is no curative therapy for IBS, the treatments aim to reduce everyday symptoms and improve bowel function. Overall, the therapy should enable those affected to lead a better life with the chronic illness and to be able to cope with everyday life more easily. Therapy is made up of various components. The most important are nutrition, behavioral training, and coping with stress. But medication is also advisable in severe cases.
If the child is fed a balanced diet based on age, a change in diet for therapy should be avoided. However, if the child is malnourished, the diet should be changed to a balanced and age-appropriate diet. If a food intolerance or allergy has been diagnosed, the diet must be adjusted accordingly.
The most common intolerances in children include fructose and lactose intolerance. However, other intolerances such as histamine, FODMAP, and gluten intolerance also occur in children. If certain foods are poorly tolerated, they can trigger irritable bowel symptoms. A diet restriction due to intolerance or allergies should always be discussed with a doctor, as this increases the risk of malnutrition. Qualified nutritional advice can also provide good help.
Studies have found that probiotics can be particularly useful for diarrhea. Probiotics are microorganisms that are similar to the microorganisms of the digestive tract. The use of probiotics has not yet been fully researched and should be discussed with your pediatrician.
Behavioral training, exercise, and coping with stress
IBS occurs frequently together with a child's psychological stress. To be able to treat these stress factors, psychosocial therapy can be used. Proven therapy options include cognitive behavioral training or gut-directed hypnosis. With cognitive behavioral therapy, children with a therapist how to assess situations and develop coping behaviors. The child can then find their way better in situations where they previously felt uncomfortable and can experience some relief.
So far, symptom diaries and relaxation procedures such as yoga or progressive muscle relaxation have shown good effects for coping with stress.
Adequate exercise is also an important factor. Affected children often tend to limit their activity because of the symptoms. However, this is counterproductive because moderate exercise has a positive effect on the symptoms.
9. How can parents support children with iIBS?
Even if no organic causes for IBS are known, the child's symptoms should be taken seriously and treated. Close care by a qualified doctor is very important. A symptom diary can help identify and change symptom triggers. During painful episodes, it helps to distract the child in a playful way, but not to overwhelm them through physical activities. If the pain is particularly severe, a pain therapist can be consulted.
10. What are the consequences of IBS for children?
Many children with IBS do not only suffer from pain, they also feel uncomfortable in social situations. Flatulence and diarrhea can cause children embarrassment, especially in kindergarten or school. There is evidence that children with chronic functional abdominal pain are more likely to develop anxiety or depression. Chronic abdominal pain in childhood can also increase the risk of other physical and mental symptoms such as headaches and anxiety disorders. Supportive psychosocial care is therefore important: Not only can it treat triggers, it also shows the child how to deal with the disease in social situations.
Ellert, U., Neuhauser, H., Roth-Isigkeit, A., 2007. Schmerzen bei Kindern und Jugendlichen in Deutschland: Prävalenz und Inanspruchnahme medizinischer Leistungen. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 5/6 2007, pp. 711-717. Online: https://www2.uni-erfurt.de/sport/seiten/downloads/KiGGSSchmerzenEllert_Studie-Koch-2007.pdf, downloaded on 19/06/2016.
Hyams, J.S., 2016. Irritable Bowel Syndrome in Children. National Insitute of Diabetes and Digestive and Kidney Diseases. Online: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ibs-in-children/Pages/facts.aspx, downloaded on 19/06/2016.
Layer, P., Andresen, V., Pehl, C., Allescher, H., Bischoff, S.C., Classen, M., Enck, P., Frieling, T., Haag, S., Holtmann, G. and Karaus, M., 2011. S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Verdauungs-und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM). Z Gastroenterol, 49(2), pp.237-293. Online: http://www.dgvs.de/fileadmin/userupload/Leitlinien/Reizdarmsyndrom/LeitlinieReizdarmsyndrom.pdf, downloaded on 23/01/2016.
Stanford Children’s Health, 2016. Irritable Bowel Syndrome in Children. Online: http://www.stanfordchildrens.org/en/topic/default?id=irritable-bowel-syndrome-in-children-90-P01983, downloaded on 19/06/2016.