Irritable bowel syndrome (IBS) is a GI disorder that changes the function of the GI tract, from muscle movement to what signals are sent from the intestines to the brain. These microscopic changes result in the symptoms that categorize IBS, including abdominal pain and problems with constipation and diarrhea.
"IBS is similar to pain from a migraine," says Rina M. Sanghavi, M.D., FAAP, MBA, Director of Neurogastroenterology and GI Motility at Children's Health℠ and Associate Professor at UT Southwestern. "You can't see something wrong even if you do the best scans, but there is a definite change in bowel function."
While it's rare for children younger than 6 to have IBS, it can be fairly prevalent in teenagers. It's estimated between 6–14% of teens experience IBS.
What are the symptoms of IBS in children?
The symptoms of IBS can be caused by different triggers in each child. For instance, your child may experience symptoms if they eat certain foods, after a big meal or when they feel stressed.
Common IBS symptoms in kids include:
- Abdominal cramping and pain
- Changes in bowel movements
- Passing mucus in a bowel movement
To be diagnosed with IBS, children must meet certain criteria, called the Rome IV criteria, which include:
- At least one day of abdominal pain per week for three months that is associated with two or more of the following:
- Pain is increased or unchanged after pooping
- Your child poops less often (constipation)
- Your child's poop changes in appearance or form (diarrhea or hardened stools)
"These symptoms cannot be attributed to any other GI cause," says Dr. Sanghavi. "It's important to rule out other causes with the help of a pediatric gastroenterologist."
Stress and IBS
Another sign of IBS to watch for is how a child's stress affects abdominal pain or bowel habits. With IBS, stress before a sports tournament, academic test or even a happy event like a birthday party can make the pain worse.
"These are typically very high achieving children, and when they are in a situation where they are anxious or stressed, their symptoms get worse," says Dr.Sanghavi.
How is IBS treated in children?
While there is no cure for IBS, effective treatment can reduce IBS symptoms in kids. One important treatment is cognitive-behavioral therapy (CBT). CBT can help quiet the loud and unnecessary nerve signals from the gut to the brain that occur when IBS is present.
"Cognitive behavioral therapy or other desensitization techniques can help the brain send ‘be quiet' signals to the gut," says Dr. Sanghavi. "It shows the most consistent benefit and is the most long-standing therapy for IBS."
Your child's care team may also suggest:
- Managing nutrition and digestion with a pediatric gastroenterologist
- Managing stress and behavior with a pediatric psychologist
- Reducing pain with a pain medicine specialist
Managing nutrition and digestion
A pediatric gastroenterologist will monitor your child's digestive health. Your child may need to change their diet or eating behaviors. In some cases, they may also benefit from fiber supplements or anti-diarrhea medicines to improve digestion.
It's important to note that there isn't one diet that is best for children with IBS. While adults with IBS often try the FODMAP diet, which focuses on removing sugars from the diet, it is too restrictive for growing children.
Dr. Sanghavi recommends her patients keep a food diary to identify problem foods. IBS may be triggered by high-fiber foods, lactose or gluten. A food diary can help determine which, if any, of these foods should be removed from your child's diet.
Managing stress and behavior
Another important aspect of treatment is to figure out stressors that can trigger IBS symptoms. If your child's IBS gets better on weekends or over the summer, that might be a signal that their work and activity load during the school year is too high.
"It's important for kids and parents to know that it's okay to pull back from schedules and participate in fewer activities or advanced classes," says Dr. Sanghavi. "That, in itself, can help keep IBS under control."
In severe cases of IBS, children may be prescribed anti-anxiety medicine or anti-seizure medicine to help calm symptoms while they learn CBT techniques. A pain medicine physician may also prescribe medicine to help fight abdominal pain so your child can stay in school and activities.
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