IBS in Children: 10 Essential Questions

Irritable bowel syndrome (IBS) is a chronic digestive disorder that can impact people of all ages, including children. IBS in children can be particularly challenging because children may struggle to identify and communicate symptoms in a way that adults understand. IBS is a group of symptoms that includes abdominal pain with diarrhea, constipation, or both.

IBS is called a functional gastrointestinal disease (FGID). This means it is a disorder of how the gastrointestinal (GI) tract works, rather than a structural or biochemical abnormality. The GI tract of children with IBS usually does not have any visual signs of damage or disease.

Symptoms of IBS in children occur repeatedly over time. Researchers aren’t sure exactly what causes IBS in children, but it is believed to be a combination of factors clustered together that creates symptoms. These factors might be environmental, psychosocial, and biological. IBS might run in families.

1.Are children affected by IBS?

It's more common for a person to be diagnosed with IBS as an adult, but it is possible for a child to have IBS. IBS symptoms often mimic other GI disorders, so it can be difficult to diagnose IBS in children.

A medical diagnosis of IBS requires over two months of abdominal pain with changes in bowel movements (either constipation or diarrhea) for over four days per month.

2. How common is IBS in children?

In the United States, it is reported that 1.2 to 2.9 percent of the children are affected by IBS. This number might be much lower than the actual incidence of IBS in children, since it’s likely that many children go undiagnosed. Some studies report a prevalence of IBS of 5 to 20 percent in children and adolescents.

IBS is one of the most common functional gastrointestinal disease types and a very common cause of long-term and recurrent abdominal pain in children and adolescents. Reports indicate that IBS is more common in young children than in adolescents. Symptoms might resolve spontaneously with increasing age. IBS is thought to affect boys and girls equally in childhood and adolescence.

3. What are IBS symptoms in children?

Symptoms may be different from one child to another, but common symptoms include:

• Recurrent abdominal (belly) pain
• Gas, bloating, and feeling full
• Abdominal cramps
• Constipation
• Diarrhea
• Sudden irresistible need to pass bowel movements
• Feeling of incomplete emptying after bowel movement
• Mucus in the stool
• Loss of appetite
• Upset stomach
• Nausea

Depending on the frequency and appearance of bowel movements, IBS can be divided into different subtypes:

• IBS-D: IBS with mainly diarrhea
• IBS-C: IBS with mainly constipation
• IBS-M: IBS with both diarrhea and constipation
• IBS-U: so-called unclassified IBS; stool consistency doesn’t meet the criteria for IBS-D, IBS-C, IBS-M

4. What are warning signs of IBS in children and adolescents?

Parents of children with IBS often become accustomed to helping their child manage the symptoms of the disorder. If new symptoms occur, there could be a more severe underlying condition that warrants medical treatment. Symptoms that should prompt a parent to seek medical care include:

• Fever
• Belly button pain
• Pain spreading from one area to another
• Constant upper abdominal pain
• Heavy diarrhea
• Nighttime diarrhea
• Blood in the stool
• Mucus (snot) in the stool
• Unexplained weight loss
• Growth and development disorders like delayed puberty
• Fatigue
• Family history of inflammatory bowel diseases like. Crohn's disease, ulcerative colitis), celiac disease, or peptic ulcer disease
• Swallowing difficulties
• Pain with swallowing
• Recurrent vomiting
• Joint inflammation or arthritis

5. Why is IBS a special challenge for children?

IBS is particularly difficult to diagnose in children because they have difficulty describing and localizing their symptoms. Between the ages of 8 and 12, children are usually able to better describe their symptoms.

Children with irritable bowel syndrome often feel generally unwell or fatigued. Parents may notice that IBS has a negative impact on grooming, school performance, and social interactions. Frequent bathroom breaks, pain, or bloating can make children feel uncomfortable and embarrassed around peers. Many children with IBS find the condition stressful.

Children with IBS usually develop and grow normally. Symptoms might even resolve spontaneously with increasing age. In some cases, affected children consciously eat less to avoid the pain that occurs during digestion. This can lead to weight loss or being underweight.

6. What causes IBS in children?

Medical professionals aren’t certain exactly what causes irritable bowel syndrome in children.

One theory is that the intestines of children with IBS are sensitive to foods or stressors that usually don’t cause other people distress (visceral hypersensitivity).

It’s also believed that an overgrowth of bacteria in the intestine might play a role in the development of IBS. Some IBS symptoms start after a gastrointestinal infection caused by bacteria (post-infectious IBS) or taking medication (especially antibiotics).

To date, no specific genetic causes are known to be associated with IBS. However, the risk of IBS is increased in children whose parents or siblings also have IBS. An interplay of genetic, environmental, and social factors might be responsible for this.

As is common with many diseases that can’t be visualized, there may be some perception that IBS has psychological causes. This perception is untrue, but there is a relationship between IBS and stress. Stress can worsen IBS symptoms, and IBS symptoms likely cause stress.

7. How is IBS diagnosed in children?

IBS in children can be diagnosed after a medical and family history, as well as a physical examination, are performed by a healthcare provider.

The criteria for the diagnosis of gastrointestinal disorders in children, including IBS, is referred to as ”the Rome IV criteria.” An IBS diagnosis can be made if the following symptoms have been present for two months:

• Abdominal pain at least four days a month.
• Bowel movement improves or worsens pain
• Change in bowel movement habits with changed stool shape and frequency
• Pain doesn’t disappear following bowel movements in children with constipation
• No other medical condition can be identified

IBS symptoms are also typical of many other disorders of the intestine, like celiac disease (often called gluten intolerance), inflammatory bowel disease, or carbohydrate malabsorption. These conditions should all be excluded before a child is diagnosed with IBS.

In addition to the physical examination, the following tests are commonly used during the diagnostic investigation:

• Blood test
• Urine test
• Stool test
• Hydrogen breath tests might also be performed to rule out lactose or fructose intolerance. In this case, an elimination diet might be recommended to eliminate the offending foods.

8. What are the treatment options for children with IBS?

Since there is no cure for IBS, the treatment for IBS aims to reduce everyday symptoms and improve bowel function. Treatment for IBS should ideally lead to better overall functioning and quality of life.

More research is needed on treatments for IBS in children. Currently, only a few high quality studies have been conducted on treatment of IBS in children and adolescents. Treatment options for IBS in children include dietary modification, behavioral therapy, and medication in cases when symptoms are severe.

Diet for children with IBS

Small studies suggest that a low-FODMAP diet might be effective in children with IBS. FODMAP stands for fermentable oligo-, di-, mono-saccharides and polyols. FODMAP are small, fermentable carbohydrates that can be hard to digest. Reducing the amount of FODMAP in the diet can lead to an improvement of symptoms, especially abdominal pain, bloating, gas, and diarrhea. It’s believed that this diet may lead to changes in the intestinal flora that can relieve some IBS symptoms.

There’s some evidence that increases in dietary fiber may help adults with IBS. There is a lack of evidence concerning the efficacy of increased fiber in children, so high fiber diets are not recommended in children with IBS. Several studies indicate that probiotics might be useful in IBS management. Probiotics are microorganisms that are similar to the microorganisms living in the digestive tract. Probiotics are found in fermented foods including sauerkraut, tempeh, kimchi, miso, kombucha, and pickles, or in over-the-counter supplements.

Behavioral training for children with IBS

IBS and stress can have an interdependent relationship. In some cases, identifying and treating stressors can improve IBS symptoms. Both cognitive behavioral therapy and gut-directed hypnotherapy (hypnosis) have been studied as treatment for IBS symptoms with favorable results. Cognitive behavioral therapy teaches children with IBS how to assess situations and develop coping behaviors. Gut-directed hypnotherapy uses deep relaxation and suggestion to alleviate symptoms.

Children might also be encouraged to maintain a symptom diary to feel empowered to address their IBS triggers. Relaxation techniques, like yoga and progressive muscle relaxation, may be beneficial at curbing the stress that can exacerbate IBS episodes. Introducing moderate exercise may also improve symptoms.

Medication for children with IBS

There is currently no evidence that medication can improve IBS in children. IBS is highly individual, however, and your healthcare provider may recommend a medication they think could reduce IBS symptoms in your child. Some studies report that peppermint oil may be the first drug of choice in children with IBS suffering from diarrhea or constipation.

9. How can parents support children with IBS?

Even if the causes of IBS can’t be identified, IBS management includes different approaches, like counselling and parental education, medication, and other non-pharmacological options like dietary changes and moderate activity. In rare cases, if the pain is particularly severe, a pain specialist 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 socially. Flatulence and diarrhea can cause embarrassment, especially in social and educational settings. There is evidence that children with chronic functional abdominal pain are more likely to develop anxiety or depression than other children.

Chronic abdominal pain in childhood can also increase the risk of other physical and psychosocial symptoms such as headaches, anxiety disorders, and school absenteeism. Supportive psychosocial care from parents is as important as symptom management. With the right guidance from parents, children can learn how to cope with IBS both psychologically and socially.