Pediatric Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a long-term (chronic) disorder that affects the large intestine or colon. IBS causes painful belly (abdominal) and bowel symptoms.

With IBS, the colon appears normal. But it doesn’t work the way it should.

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 bacteria growing in their bowel

All these things can cause IBS symptoms. You should stress to 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.

Each child’s symptoms may vary. Symptoms may 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 irritable bowel syndrome 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.
• Stool samples for occult blood. Occult blood cannot be seen. It is only found using a special solution that turns blue when it comes into contact with blood. If blood is found, there may be inflammation in the GI (gastrointestinal) tract.
• 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.
• 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.

Your child’s healthcare provider will create a care plan based on:

• Your child's age, overall health and medical history
• How serious your child’s case is
• How well your child handles certain medicines, treatments or therapies
• If your child’s condition is expected to get worse
• Your opinion and what you would like to do

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).
• High fiber for children is controversial since it could promote gas and bloating. It is recommended for adults, and it may help children who have constipation.
• 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.

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.

A child with irritable bowel syndrome often doesn’t feel well. And the physical symptoms of IBS can lead to stress and emotional problems. For example, children with diarrhea may not get to the bathroom in time. This can make them feel embarrassed. They may then not go to school or play with friends. This can cause depression and anxiety.

Most children with IBS continue to grow and develop normally. But some children may eat less to limit the pain that can go along with digestion. This can lead to weight loss.

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

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

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

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.

If your child is having emotional issues, watch them for thoughts of suicide. Call your child's provider right away if your child is talking about suicide in person or on the internet, giving away belongings, using illegal drugs or alcohol, or expressing increased thoughts about death. The 988 Suicide and Crisis Lifeline (formerly the National Suicide Prevention Lifeline): Call or text 988, available 24 hours a day, 7 days a week.