Irritable bowel syndrome in children

It’s not unusual for children to complain of an upset belly or stomachache. Most of the time, it’s nothing serious, but how can parents know if their child’s tummy troubles are a sign of something more? To help answer this question, we turn to Alda Taube, NP, PPG – Pediatric Gastroenterology, to explain what irritable bowel syndrome is and how it can manifest in children.

What is irritable bowel syndrome?

Irritable bowel syndrome is a common disorder that affects the large intestine. IBS usually exhibits a group of symptoms that occurs together, including repeated pain in the abdomen. It is a long-lasting, chronic condition that many need to manage over time. A small number of people with IBS have severe symptoms, while others can control their condition by managing their diet, lifestyle and stress.

What causes IBS in children?

IBS itself is a disorder of unknown etiology. IBS in children is often due to risk factors, including chronic stress, anxiety, depression, a history of trauma or acute gastroenteritis, and intestinal imbalances. Often, there is also a strong familial component, with up to 33% of children with the condition having family members who also suffer from IBS.

What are the warning signs and symptoms?

Some warning signs and symptoms of IBS can include cramping, abdominal pain, bloating, gas, diarrhea, constipation or both, plus a change in bowel habits. The most common symptom of IBS is pain in your abdomen, often related to bowel movements and/or changes in bowel movements. These changes may be diarrhea (IBS-D), constipation (IBS-C) or both (IBS-M), depending on the type of IBS. Children with IBS often have these symptoms without any visible signs of damage or disease in the digestive tract.

How is childhood IBS diagnosed?

In most cases, a provider will review the patient’s symptoms, medical and family history, and perform a physical exam and possibly order testing. They will look for any patterns in symptoms. Patients with IBS must also meet the ROME IV criteria, which includes the following:

• Abdominal pain at least four days per month associated with one or more of the following:
  • Related to defecation or bowel movement
  • A change in frequency of stool
  • A change in form or appearance of stool
• In children with constipation, the pain does not resolve with the resolution of constipation
• After appropriate evaluation, symptoms are unexplained by another medical condition

How is IBS treated in children?

Families need to understand that the goal of therapy or treatment is not complete elimination of pain/discomfort but rather the ability to resume previous daily activities. Possible treatment options or therapies could include:

Pharmacotherapy

• Antispasmodic: These help decrease the smooth muscle spasm in the GI tract.
• Antidepressants: These can help the neurotransmitter in the gut, but patients must get an EKG before administration.
• Antireflux agents (H2): May effectively improve heartburn symptoms but haven’t been shown to improve abdominal pain.
• Antihistamine agent: This may improve gastric accommodation and nausea.

Non-Pharmacotherapy

Dietary interventions may also help children with the condition. Some strategies may include:

• Gluten-free diet: Eliminating this may help reduce the symptoms of IBS-D.
• Low-FODMAP diet: May help reduce diarrhea, bloating and flatulence with IBD-D.
• Lactose and fructose-free: Eliminating these may help IBS symptoms in general.                                

Can children with IBS live normal healthy lives?

Yes, children with IBS have the potential to reduce their symptoms and live healthy normal lives by following a balanced diet, proper nutrition, pharmacotherapy and stress management practices. While there is no cure for IBS, parents and caregivers can help their child by ensuring the condition does not affect their daily routine. Parents can also help their child by:

• Focusing on their overall health
• Taking them to regular doctor visits
• Making appropriate changes to their diet and lifestyle
• Keeping track of their symptoms and triggers
• Ensuring their child is getting enough rest and sleep
• Being supportive and advocating for their child

Support groups are also a good way for children and their parents to connect with others going through similar situations, find better ways to manage symptoms, feel better and have a positive outlook on life.

When should parents seek medical intervention for their child?

Parents and caregivers should seek medical intervention when their child is experiencing or having abdominal pain, cramping, gas, mucus in the stool, severe diarrhea and/or constipation. Anytime your child experiences new or worsening symptoms that affect their daily activities, it’s best to speak with your provider.