Is It IBS? Identifying Irritable Bowel Syndrome in Kids

For most kids, tummy aches are a normal part of growing up. But for up to 5% of children between the ages 4 to 18 years, they may be a symptom of irritable bowel syndrome (IBS), an intestinal disorder that can cause belly pain, gas, diarrhea, and constipation.

According to Dr. Timothy Menz, a pediatric gastroenterologist with Baystate Pediatric Gastroenterology & Nutrition, the exact cause of IBS in children is unclear but there’s no question that it can be disruptive to the life and activities of a child as well as their family.

“One of the challenges of IBS in kids is that no two children experience the condition the same way,” says Dr. Menz. “It can present in a number of different ways and determining what type of IBS a child has is key to making an appropriate treatment decision.”

Symptoms and Types of Pediatric IBS

The main symptom of pediatric IBS is a belly ache or abdominal discomfort. The pain can be experienced in different ways, including as a sharp pain, cramping, burning, bloating, or a feeling of fullness

Beyond the abdominal discomfort, symptoms vary from patient to patient, says Dr. Menz, which leads to classifying childhood IBS into types based on their symptoms.

The types of IBS include:

• IBS-C: IBS with constipation
• IBS-D: IBS with diarrhea
• IBS-M: IBS with constipation and diarrhea
• IBS-U: IBS not otherwise specified

Diagnosing IBS in Children

According to Dr. Menz, “The first criteria for making a diagnosis is experiencing symptoms for at least 4 days per month that have been going on for the last 2 months or longer.”

Beyond that, a diagnosis of IBS in children is made from the patient’s history, physical exam, and overall growth. Additional testing may be necessary to rule out other conditions with similar symptoms that may overlap with IBS.

“Symptoms of IBS can be similar to those of inflammatory bowel disease (IBD), a group of chronic inflammatory conditions of the gastrointestinal tract, as well as celiac disease, among others. In the diagnostic process we’re looking to rule out those diseases so that the proper treatment can be recommended.”

Diagnosing IBS in kids involves:

• A medical history review: When did symptoms start? What medications have you tried? Any recent infections? Have you done any travel?, etc.
• A physical exam: Assessing overall growth and listening to lungs and heart and checking for any abdominal tenderness
• Laboratory testing: in some cases, additional testing including blood work, stool studies, abdominal imaging, and an endoscopy may be required to rule out other diagnoses such as IBD, celiac disease, or infections of the GI tract.

What Causes IBS in Kids

Once a diagnosis of IBS is confirmed, the focus for the doctor and patient is understanding not only how to manage the symptoms but also finding out the underlying cause.

“In the same way the symptoms of IBS can vary from patient to patient, so can the cause of IBS,” says Dr. Menz.

In some cases, the root of IBS is an issue with how food moves through a child’s digestive system. In others, a child may have an extreme sensitivity to pain in their intestines (visceral hyperalgesia) triggered by the normal stretching and motion that occurs during digestion.

“Another common cause,” notes Dr. Menz, “is basically an imbalance in the gut microbiome, sometimes caused by an infection, a recent course of antibiotics, or eating a lot of processed foods, all of which can trigger IBS.”

Determining the underlying cause of IBS can also be aided by examining what seems to make the symptoms worse.

“Food intolerances, such as gluten and lactose, are usually easy to identify as IBS triggers,” says Dr. Menz, “but other factors that contribute to the condition are chronic stress, a family history of IBS or anxiety, prior gastrointestinal issues, and prior surgeries.”

All this information, says Dr. Menz, informs the most appropriate treatment option for each patient.

Treating Pediatric IBS

Because there is no cure for IBS, children will not just grow out of it, unfortunately. The goal of treatment is to ease symptoms as much as possible so that your child can get back to normal daily activities. Potential treatment options may include dietary changes, medication, and psychological or behavioral therapy.

Dietary Changes: Low FODMAP Diet

The most frequently recommended treatment option, the low FODMAP diet is a temporary, restrictive eating plan. Dr. Menz explains, “FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are carbohydrates that the small intestine absorbs poorly. For many, they trigger IBS symptoms. A low FODMAP diet works by first cutting out those foods and then slowly reintroducing them to determine which ones may be the source of the IBS symptoms. From there, it’s possible to build a diet that meets your nutritional needs while reducing or potentially eliminating IBS symptoms.

Other foods may impact your child's IBS symptoms, so watch out for how they respond to common childhood foods like milk, chocolate, fatty or greasy foods, or spicy foods.

Lifestyle Modifications

Improving overall health can help alleviate some symptoms of childhood IBS. Dr. Menz recommends regular exercise, a consistent and sufficient sleep routine to boost well-being and give children a feeling of control in their lives.

Medication

Different medications may be recommended based on the type of IBS your child has. Dr. Menz cites these as common options for providing symptom relief:

• Laxatives for IBS-C
• Antispasmodics for IBS-D or IBS-M
• Peppermint oil for all types of IBS
• Antidepressant if other medications are ineffective

He notes that while the evidence regarding the use of probiotics is mixed, some studies suggest they can help with abdominal pain, but more studies need to be done. What’s most important is that they are generally safe to use. “You just have to appreciate that they’re not a magic solution.”

Psychological and Behavioral Therapy

Living with IBS can take a mental toll on children. Different behavioral therapy practices can work to distract the brain from IBS and reduce stress. “Hypnotherapy, acupuncture, yoga therapy, and other practices all have the potential to help alleviate symptoms.”

When to Worry About IBS in Kids

While an occasional tummy ache isn’t too concerning, Dr. Menz notes there are certain things that should motivate caregivers to seek medical attention for their child. These include:

• Worsening abdominal pain, diarrhea, or constipation over the course of 2 months
• Weight loss 
• Bloody diarrhea
• Recurrent symptoms with a positive family history of IBD, celiac disease, or other autoimmune disorders

“If left untreated, IBS can have a major negative impact on your child’s daily activities, ability to focus and participate in school, and overall health,” says Dr. Menz. “If you have concerns, even if they don’t reach the level noted here, schedule an appointment with their pediatrician. The sooner IBS is diagnosed, the sooner treatment can begin to bring relief to your child.”