Irritable Bowel Syndrome (IBS) in Children
Overview
Irritable bowel syndrome (IBS) is a
long-term (chronic) disorder that affects the intestine. IBS causes painful belly
(abdominal) and bowel symptoms.
With IBS, the colon appears normal.
But pain and a change in bowel habits happen.
Causes
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.
Risk Factors
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.
Symptoms
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 3 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.
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 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 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.
Treatment
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.
Complications
A child with IBS 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.
Living with
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 methods
- 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
When to Call a Healthcare Provider
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.
I
Key Points
- IBS is a long-term (chronic) disorder
that affects the large or small intestine.
- IBS causes painful belly and bowel
symptoms. It is defined as abdominal pain or cramping with a change in bowel habits,
such as diarrhea or constipation.
- Try to find the triggers that cause
your child's symptoms. Then teach your child to stay away from those triggers.
- There is no cure. The goal of
treatment is to ease symptoms and help your child get back to normal daily
function.
- IBS symptoms can affect your child’s
daily activities. Work with your child’s healthcare provider to manage the
disease.
Next Steps
Tips to help you get the most from
a visit to your child’s healthcare provider:
- Know the reason for the visit and what
you want to happen.
- Before your visit, write down
questions you want answered.
- At the visit, write down the name of a
new diagnosis and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you for your child.
- Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects
are.
- Ask if your child’s condition can be
treated in other ways.
- Know why a test or procedure is
recommended and what the results could mean.
- Know what to expect if your child does
not take the medicine or have the test or procedure.
- If your child has a follow-up
appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s
healthcare provider after office hours. This is important if your child becomes ill
and you have questions or need advice.