What to Know About IBS in Children

The term irritable bowel syndrome (IBS) applies to a group of digestive symptoms rather than a standalone disease. These symptoms typically occur together and may include abdominal pain and changes in bowel movements. IBS is typically described as a functional gastrointestinal disorder.

Irritable bowel syndrome affects somewhere between 25 and 45 million people of all ages and sexes, though about 2 in 3 individuals with IBS are female. While IBS can develop at any age, it can be particularly difficult to diagnose in children.

Here’s what you need to know about IBS in children, including the different types, their symptoms, and how to properly manage it.

The Four Types of IBS in Kids

Although research and studies have been performed since its inception, the exact cause of IBS is unknown. What’s even more frustrating for those diagnosed is that it may affect people in different ways. In children, symptoms of IBS may be present without any identifiable signs of disease or damage in the digestive tract. While IBS symptoms may come and go, experts have identified four specific patterns of bowel movement changes present in children with IBS.

The four types of IBS in children include:

1. IBS with Constipation (IBS-C)
2. IBS with Diarrhea (IBS-D)
3. IBS with Mixed Bowel Habits (IBS-M)
4. IBS Unsubtyped (IBS-U)

Children with IBS-C typically exhibit stools that are hard or lumpy more than 25% of the time with loose or watery stools less than 25% of the time. In IBS-D, the ratio is swapped. IBS-M involves more than a quarter of stools being hard or lumpy and more than a quarter being loose or watery. In IBS-U, both hard or lumpy stools and loose or watery stools occur less than 25% of the time.

Risk Factors and Symptoms

Statistics from the American College of Gastroenterology suggest that between 10 and 15 percent of adults in the United States suffer from IBS symptoms, though only 5 to 7 percent are diagnosed.

Research suggests that IBS affects roughly 5 percent of children between 4 and 18 years of age. Though IBS can affect anyone, it is more commonly seen in children who have a history of:

• Mental or emotional health problems (like depression and anxiety)
• Bacterial infections of the digestive tract
• Painful or inflammatory conditions in infancy or early childhood (like allergies or surgery)
• Childhood abuse
• Family members who have IBS

The most common symptoms of IBS in adults are gas, bloating, abdominal pain or cramping, and diarrhea or constipation (or both). Children often exhibit either diarrhea or constipation as a dominant symptom, though some alternate between the two.

Here is a more comprehensive list of IBS symptoms in children:

• Constipation
• Diarrhea
• Diarrhea alternating with constipation
• Gas
• Bloating
• Loss of appetite
• Recurring abdominal pain (>3 months)
• Nausea
• Vomiting
• Mucus in the stool
• Bowel movement urgency
• Sensation of incomplete bowel movement

While IBS can be a painful condition, it generally doesn’t damage the digestive tract or lead to other health problems. It can, however, significantly disrupt your child’s life, so it should be managed properly.

Tips for IBS Management in Children

The first step in managing IBS in children is to obtain a clinical diagnosis. The symptoms of IBS may overlap with other health issues, so it’s wise to bring your concerns to your child’s pediatrician as soon as possible.

Because IBS is a collection of symptoms and there is no biomarker, diagnosis is typically made by ruling out other potential causes for the symptoms. If your child experiences weight loss, vomiting, bloody stools, delayed growth, unexplained fever, or an enlarged liver, something other than IBS is likely involved. Your doctor will perform a health history and physical exam but may recommend additional testing such as blood tests, urinalysis, stool samples, abdominal x-ray or ultrasound, and endoscopy or colonoscopy.

As of today, there is no cure for IBS – the main course of treatment involves symptom management. Your child’s pediatrician may recommend medication to manage severe symptoms, though the best management tools for mild symptoms are typically dietary changes.

A low FODMAP diet is one of the most effective treatments for IBS in adults and could be beneficial for a child as well. However, significant effort should be made to liberalize the diet as much as possible in order to avoid triggering food fears and disordered eating patterns. In many cases, some children benefit from supplemental fiber or probiotics. Helping your child learn to manage stress and anxiety can also play a key role in reducing symptoms of IBS.

Here are some additional tips for managing IBS in children:

• Make efforts to identify your child’s IBS triggers (things like large meals, fatty foods, or dairy).
• Limit your child’s intake of caffeine and artificial sweeteners.
• Keep a food diary to track IBS symptoms and link them to certain foods or triggers.
• Make sure your child is involved in the treatment process and understands why the changes to their diet and lifestyle may be necessary.
• Teach your child relaxation techniques to help manage stress.
• Consider cognitive behavioral therapy to help your child cope with IBS challenges.

While IBS isn’t a curable condition, symptoms can be managed with dietary changes and awareness on your part as a parent or caregiver. Talk to your child’s doctor to confirm the diagnosis and to discuss the best steps for treatment.