Irritable Bowel Syndrome in Children - Digestive Diseases - Digestive

IBS is a functional gastrointestinal disorder marked by abdominal pain or discomfort, bloating, and irregular bowel habits, such as diarrhea or constipation. Functional gastrointestinal disorders are defined by their symptoms. IBS can cause a great deal of discomfort and distress, but it is not life threatening, does not damage the bowel, and does not progress to other diseases. IBS should not be confused with inflammatory bowel disease (IBD), a group of diseases including ulcerative colitis and Crohn's disease.

IBS is common in people of all ages, including children. About 14% of high school students and 6% of middle school students report IBS-like symptoms.

IBS affects boys and girls equally, although in adults it is more common in women than in men.

abdominal pain or discomfort
intestinal bloating
irregular bowel habits, including diarrhea, constipation, or both
a change in the appearance of stool, including stools that are loose, hard, thin, or pelletlike
mucus in the stool
the need to strain to have a bowel movement
a sense of urgency when having a bowel movement
the sensation of not completely emptying the bowels

IBS is diagnosed based on symptoms. A diagnostic manual called Rome III guides doctors in diagnosing and treating functional gastrointestinal disorders, including IBS. According to Rome III, for a child to be diagnosed with IBS, abdominal pain or discomfort must be present at least 1 day per week for a period of two months or longer. Two or more of the following must also occur at least 25% of the time:

The pain or discomfort is relieved by having a bowel movement.
The pain or discomfort is associated with an increase or decrease in the number of bowel movements.
The pain or discomfort is associated with a change in the appearance of stool.

No test can show if a person has IBS; however, a doctor may run tests to rule out diseases with symptoms similar to IBS. Signs and symptoms that suggest a problem other than IBS include:

persistent pain in the upper right or lower right area of the abdomen
difficulty swallowing
persistent vomiting
gastrointestinal bleeding
waking up during the night with diarrhea or because of abdominal pain
a family history of IBD, celiac disease, or peptic ulcer disease
arthritis
inflamed, pus-filled masses around the rectum, also called perirectal disease
involuntary weight loss
a sudden stop in height growth
delayed puberty
unexplained fever

No cure for IBS exists; however, treatment can reduce symptoms. Treatment is guided by the symptoms present, their severity, and the child's response to treatment. Treatment includes dietary changes, medication, and stress management.

Reducing or eliminating certain foods may improve symptoms. Common trigger foods include fatty foods, dairy products, carbonated beverages, and caffeine. Keeping a diary of symptoms, bowel habits, and diet may help identify foods that trigger IBS symptoms.
Eating high-fiber foods, such as fruits, vegetables, and whole grain breads and cereals, may also help. Fiber helps relieve constipation and promotes regular bowel movements.
Eating several small meals throughout the day instead of a few large ones may reduce symptoms.
Fiber supplements, such as Metamucil or Citrucil, help control constipation.
Laxatives, such as PEG 3350 (MiraLax, GlycoLax), mineral oil, or bisacodyl (Dulcolax), relieve moderate to severe constipation.
Loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol) help relieve diarrhea.
Antispasmodics, such as dycyclomine (Bentyl), relax smooth muscle contractions in the bowel and can, theoretically, lessen pain related to IBS but should be used with caution due to potentially serious side effects.
Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), are used to treat IBS, although their effectiveness in children is not well documented.

Before taking any of these medications, children and their parents should seek the advice of a health care provider to help weigh the potential benefits against the risk of possible side effects.

Understanding that IBS is not a life-threatening disease can help reduce a child's anxiety, which may in turn lessen IBS symptoms. Certain types of counseling, including cognitive behavior therapy and hypnotherapy, have been shown to help manage IBS symptoms. Parents can help reduce a child's stress by discussing potential IBS-related issues with school personnel — for example, the need for ready access to a private restroom.

International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217–8076
Phone: 1-888-964-2001 or 414-964-1799
Fax: 414-964-7176
E-mail: iffgd@iffgd.org
Home page: www.iffgd.org/

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition
P.O. Box 6
Flourtown, PA 19031
Phone: 215–233–0808
Fax: 215–233–3918
Email:naspghan@naspghan.org
Internet: www.naspghan.org

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was reviewed by Jeffrey S. Hyams, M.D., Connecticut Children's Medical Center.