Is it IBS? Understanding irritable bowel syndrome in children

By Dr Rohan Malik

Paediatric gastroenterologist in Woolloongabba, Brisbane

Irritable bowel syndrome, or IBS, is often thought of as an adult condition. But children and teenagers can experience it too.

For a child with IBS, tummy pain and changes in their bowel habits can become an ongoing part of life. They may have periods when symptoms are relatively settled and others when they flare up, sometimes interfering with school, sport, social activities or simply feeling comfortable enough to get on with their day.

So how do you know whether IBS could be behind your child’s symptoms?

What is IBS?

IBS is a condition that affects how the gut functions. It belongs to a group of conditions known as disorders of gut-brain interaction, where the communication between the digestive system and the brain isn’t working as smoothly as it should.

Unlike conditions that cause visible inflammation or damage to the bowel, IBS doesn’t usually produce abnormalities that can be seen on a scan or during an endoscopy.

That doesn’t make the symptoms any less real.

In IBS, the bowel can become more sensitive, and its usual patterns of movement can change, resulting in pain and altered bowel habits.

What does IBS look like in children?

The combination of symptoms is important.

A child with IBS typically experiences recurrent abdominal pain together with changes in their bowel motions. Depending on the child, this may mean:

• diarrhoea
• constipation
• a mixture of diarrhoea and constipation
• a change in how often they open their bowels
• a change in the appearance or consistency of their stools
• bloating or a feeling of abdominal fullness.

The abdominal pain is related to bowel movements, although the experience can differ between children.

Symptoms may also fluctuate. A child can have a good run for a while and then find their IBS becomes troublesome again.

How do you know it’s IBS and not something else?

There isn’t a single blood test or scan that tells us a child has IBS.

Instead, diagnosis begins by looking carefully at the pattern of symptoms and the child’s medical history. A doctor will also consider whether there are signs that point towards another gastrointestinal condition.

Depending on the individual child, investigations may be needed to check for other causes of their symptoms. However, not every child needs an extensive series of tests before IBS can be diagnosed.

This is an important point. An IBS diagnosis doesn’t simply mean that ‘everything else came back normal’. There are recognised criteria doctors use to identify the condition from a child’s symptoms and clinical history.

Are there symptoms that don’t fit the usual IBS picture?

Certain features may prompt a doctor to investigate further before settling on an IBS diagnosis.

These can include:

• unexplained weight loss or poor growth
• blood in the stool
• persistent or severe diarrhoea
• ongoing vomiting
• unexplained fever
• symptoms that regularly wake a child from sleep
• a significant family history of conditions such as coeliac disease or inflammatory bowel disease.

Having one of these symptoms doesn’t necessarily mean your child has a serious gastrointestinal condition. It does mean that further assessment may be appropriate.

What makes IBS flare up?

There isn’t one universal IBS trigger.

Food may play a role for some children, while stress, disrupted routines, illness or changes in sleep can influence symptoms for others. Sometimes a flare occurs without an obvious explanation.

This is why identifying a child’s individual symptom pattern can be more useful than assuming there is one food or trigger that needs to be eliminated.

Keeping a simple record of symptoms, bowel motions and possible triggers may help reveal patterns.

How is IBS treated in children?

There is no single treatment that works for every child with IBS.

Management is based on the child’s predominant symptoms and how much those symptoms are affecting everyday life. It may involve:

• establishing regular eating and toileting routines
• dietary changes where appropriate
• managing constipation or diarrhoea
• medication to target particular symptoms when needed
• strategies that address the gut-brain connection
• support with stress or anxiety when these are contributing to symptoms.

Restrictive diets aren’t automatically the answer, particularly in growing children. If significant dietary changes are being considered, professional guidance can help make sure nutritional needs continue to be met.

Helping children manage IBS

For many families, simply having an explanation for persistent symptoms can make a difference.

IBS can be frustrating because symptoms may come and go, and there isn’t always a quick fix. But understanding a child’s individual pattern and finding the right combination of strategies can make the condition much more manageable.

The aim isn’t only to settle the bowel. It’s to help children spend less time worrying about their symptoms and more time getting on with being children.