Pediatric Irritable Bowel Syndrome (IBS)

The exact physical cause of IBS is not known. A child with IBS may have a colon that is more sensitive than normal. This means the colon has a strong reaction to things that should not normally affect it.

Children may feel IBS symptoms because of:

• Problems with how food moves through their digestive system
• Extreme sensitivity of the inside of their bowel to stretching and motion
• Stress
• Too much of certain bacteria growing in the small bowel
• Sensitivity to certain foods, such as lactose, fructose and sucrose
• Other conditions that can cause the same type of IBS symptoms, such as celiac disease

All these things can cause IBS symptoms. Reassure your child that the belly pain is real and not imaginary.

Children are most at risk for IBS if one or both parents have the disorder. Teens are more at risk than younger children. IBS affects boys and girls equally. A history of abuse or stressful situations can increase the risk in both children and adults.

IBS is defined as abdominal pain or cramping with a change in bowel habits, with diarrhea, constipation or both. Each child’s symptoms may vary. Symptoms may also include:

• Belly pain that keeps coming back. Pain that continues for more than three months is long-term (chronic).
• A change in bowel habits, such as diarrhea or constipation
• Upset stomach (nausea)
• Feeling dizzy
• Loss of appetite
• Swelling (bloating) and gas
• Cramping
• Needing to have a bowel movement right away
• Feeling that not all the stool has come out during a bowel movement
• Mucus in the stool

The symptoms of IBS may look like other health problems. Make sure your child sees a healthcare provider for a diagnosis.

Your child's healthcare provider will take a full health history and do a physical exam. A diagnosis of IBS is made by ruling out other causes of the symptoms.  

There are some symptoms that may point to a cause other than IBS. This can help your child's healthcare provider decide what lab tests and procedures may be needed. These symptoms include:

• Weight loss
• Vomiting
• Fever for no reason
• Bloody diarrhea
• Delayed growth
• Enlarged liver

The provider will order lab tests to check for infection and inflammation. These may include:

• Blood tests. These tests are done to check if your child has anemia, an infection, or an illness caused by inflammation or irritation.
• Urine analysis and culture. These help check for urinary tract infections.
• Stool sample. This checks for bacteria and parasites that may cause diarrhea. It can also check for inflammation in the bowel.
• Stool samples FIT testing. This test checks stool for blood. It is done more commonly than the older test, occult blood testing. If blood is found, there may be inflammation in the gastrointestinal tract.
• Breath tests. Different breath tests can be done to see if bacterial overgrowth exists, or if the child isn't digesting some sugars correctly, such as lactose, fructose or sucrose. One example is the lactose breath hydrogen test. This test is done to see if your child can’t digest lactose or is lactose intolerant. Lactose is a sugar found in milk and milk products.
• Abdominal X-ray. A simple study that gives the provider an idea of how the internal organs look.
• Abdominal ultrasound. An imaging test that shows the internal organs as they work. It makes images using high-frequency sound waves in the internal organs. Occasionally other imaging tests, such as MRI or CT scan, are done, if it's necessary to evaluate for other conditions that may mimic IBS.
• EGD (esophagogastroduodenoscopy) or upper endoscopy. A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to check the inside of part of the digestive tract. Tissue samples (biopsy) from inside the digestive tract may also be taken for testing.
• Colonoscopy. A test that uses a long, flexible tube with a light and camera lens at the end (colonoscope) to check inside the large intestine. Tissue samples (biopsy) are often taken depending on your child's symptoms and how the colon looks.

There is no cure for IBS. The main goal of treatment is to ease symptoms and help your child get back to normal daily activities. Treatment may include:

Dietary changes

• Lactose sugar can cause IBS symptoms. If your child can’t digest lactose (is lactose intolerant), it is best to limit lactose. Talk with your child’s healthcare provider about giving your child the enzyme that digests the sugar (lactase/lactaid).
• Low FODMAP diet. This diet limits foods that the child may not digest correctly and can result in IBS symptoms. However, before starting any specific diet, get guidance from your child's provider.
• Soluble fiber is often helpful, but insoluble fiber can increase gas and bloating.
• Check with your child's healthcare provider before adding good bacteria (probiotics) to your child's diet. Not all probiotics are the same, and they are not regulated by the FDA.
• You may need to make other changes to your child's diet if they have a food allergy or intolerance.
• Ask to talk to a registered dietitian if you have questions or concerns about managing the needed dietary changes.

Medicine

• If your child has severe symptoms, medicine may be needed.

Stress management

• When your child has a painful episode of IBS, try to help your child focus on something fun or pleasant.
• In rare cases, specialists may be consulted for pain control. Methods, such as biofeedback and acupuncture, may help. Mindfulness and yoga can also be helpful. There are many online apps that help teach mindfulness and yoga, and you can also do this with your child at home.
• Keep track on and manage your own stress. Caring for a child with IBS can be emotionally and physically draining. Self-care will help your child deal with their stress as well.

IBS symptoms can affect your child’s daily activities. It’s important to work with your child’s healthcare provider to manage the disease. You may need a plan to deal with issues, such as diet, school, and emotional or mental health. In an age-appropriate manner, teach your child about IBS, including how to help control the symptoms.

It is important to know the triggers that cause your child's symptoms and then stay away from those triggers. Triggers often include:

• Large meals (so eating smaller meals more often during the day may be helpful)
• Fatty foods
• Milk products
• Caffeine
• Artificial sweeteners

Keeping a food and symptoms diary may help you to better understand your child’s triggers.

Help your child find positive ways to cope. This can help them take part in school and other activities. Some methods that may be helpful include:

• Relaxation techniques
• Distraction
• Guided imagery
• Hypnotherapy
• Cognitive behavioral therapy
• Biofeedback

Talk with your child's healthcare provider and school personnel to find methods and interventions that may be right for your child.

If your child is having a hard time coping with IBS, talk with their healthcare provider. You might consider having your child see a specialist, such as a:

• Developmental-behavioral pediatrician
• Teen medicine specialist
• Mental health provider
• School psychologist or school counselor

Contact your child’s healthcare provider if your child has any of the following symptoms:

• Abdominal (belly) pain
• Long-term (chronic) diarrhea or constipation
• Any other GI (gastrointestinal) symptoms
• Unexplained weight loss

Call your child's provider right away if they have been diagnosed with IBS and develops other symptoms, including:

• Weight loss
• Vomiting
• Severe diarrhea
• Fever
• Urinary symptoms
• Bloody diarrhea
• Skin changes
• Signs of depression, such as increased isolation, sadness, irritability or loss of interest in usual activities