Irritable Bowel Syndrome in Children (Part 1)

May 30, 2023

Irritable bowel syndrome or IBS, is a chronic inflammation of the gut. It causes abdominal pain, diarrhoea, and bloody stools. It usually starts in childhood before the age of 16.

For kids, IBS can reduce their quality of life, preventing them from enjoying or participating in daily activities like learning and playing.

We sat down with Dr Jayagauri A/P Balakrishnan, Consultant Pediatrician at Columbia Asia Hospital - Petaling Jaya, to learn more about IBS in children and what parents can do if their kids have this condition.
Q1: What are some of the most common symptoms of IBS?

There are 3 subtypes in childhood IBS: Crohn’s disease (CD), ulcerative colitis (UC) and IBD unclassified (IBD-U). These diseases are not contagious and sometimes it’s hard to differentiate between them.

But we have found some common symptoms of irritable bowel syndrome (IBS) include:
  • Abdominal pain or discomfort (with varying intensity)
  • Changes in bowel movements (diarrhoea or constipation)
  • Mucus or blood in the stool
  • Fatigue
  • Joint pain: 7 to 20 percent of people with IBS suffer from arthritis, typically the large joints of the lower extremities.
  • Anxiety and depression
IBS symptoms can vary from person to person. Some may experience only a few of these symptoms, while others may experience several and the severity also varies over time.
Q2: What are some of the causes of IBS in children?

The cause of irritable bowel syndrome (IBS) in children is unclear and can have various causes.

Some of the factors or triggers that may contribute to IBS in children include:
  • Genetics
  • Certain genes that you were born with may make it more likely that you will get IBS. So, if one or both of your parents has IBS or if your child has a family history of IBS, then chances are they will inherit the condition.
  • Inappropriate Immune Response
  • This can take the form of either hyper or hypo-immunity. When a person’s immune system reacts inappropriately which causes inflammation of the intestine leading to the gastrointestinal symptoms listed previously.
  • Abnormal Gastrointestinal Motility
  • Muscles which control movement of food through the digestive system may contract too strongly or weakly, leading to IBS symptoms.
  • Microbiome Imbalance
  • Imbalance of the gut microbiome can also be blamed for IBS. This happens when the good and bad bacteria in the gut are not balanced.
  • Environment
  • Environmental factors also cause IBS symptoms. Things that you are exposed to, such as food (highly processed food) can trigger IBS symptoms. In some children the common food triggers are dairy, gluten, and high-fat foods.
  • Psychological Factors
  • Sometimes the triggers can be entirely in the mind. Stressful situations and anxiety attacks can worsen IBS symptoms especially in children.
  • Medications
  • Certain types of drugs and medical treatments can unfortunately cause IBS symptoms. For instance, taking antibiotics multiple times early in life increases the risk of IBS. Repetitive infections and exposure to toxins also known to increase the risk of IBS.
Q3: How is IBS diagnosed in children?

Doctors diagnose IBS by looking at medical history, studying the symptoms, carrying out physical examinations and other tests.

Some of the tests that doctors may use to diagnose IBS in children include:
  • Blood Tests: inflammation, haemoglobin, low blood protein, etc.
  • Stool Tests: blood, infections, inflammation markers
  • Breath Tests: bacterial overgrowth in the small intestine
  • Imaging Tests: ultrasound, barium meal, MRI, capsule endoscopy.
  • Endoscopy: intestinal examination and biopsy.
To diagnose IBS in children, doctors usually consider the symptoms the child is experiencing and the results of any tests they may undergo.

The healthcare provider will carefully evaluate the child and use their professional judgment to make the diagnosis.
Q4: How do you treat children with IBS?

The treatment of IBS in children is based on the severity of their symptoms, their age, and their individual needs. It is complex and should involve a multi-disciplinary team.

The goal of treatment includes:
  • to relieve symptoms and improve the child’s quality of life and maintaining the patient’s remission for long period of time
  • healing the intestine and preventing complications
  • to maintain normal growth and development
  • restoring quality of life
To accomplish these goals involves the implementation of the following steps:
  • Medications
  • Certain medications can help manage specific symptoms of IBS. Medication also helps control the swelling and irritation (ulcers).
    There are several types of medications used and chosen based on where the disease is located and the severity of the irritation.
    Doctors may also prescribe probiotics, which are live bacteria that promote gut health.
  • Nutritional Management
  • Dietary changes may help to alleviate IBS symptoms.
    Avoid foods that may trigger symptoms, such as high-fat foods or dairy products. Increasing fibre intake and drinking plenty of fluids.
    Poor diet can cause poor growth and poor weight gain.
    This is why it’s important that an IBS team includes dieticians who can plan an individual nutritional plan catered to your child’s specific needs.
  • Stress Management
  • Stress and anxiety can exacerbate IBS symptoms, so stress reduction techniques such as relaxation exercises, biofeedback, or counselling may be recommended.
  • Surgery
  • Surgery is an important part of effective treatment for some patients when medicine alone cannot control the symptoms or reverse the bowel damage.
Q5: How can parents help manage their child’s symptoms at home?

Depending on the symptoms, a doctor may prescribe different treatments for each child. This includes lifestyle changes and how to manage their condition at-home.

However, here are some general steps that parents can take to support their child’s if they have IBS:
  • Consistent Routine
  • Children often benefit from a regular routine that includes consistent sleep, meal, and activity times. This helps stabilise their mood, energy levels, and overall health.
  • Good Nutrition
  • A healthy and balanced diet can help reduce inflammation, boost immunity, and support overall health. Encourage your child to eat a variety of fruits, vegetables, whole grains, lean protein, and healthy fats. Limit foods which can exacerbate symptoms.
  • Hydration
  • Help your child stay hydrated which can help reduce symptoms like constipation. Encourage your child to drink plenty of water and limit sugary drinks.
  • Manage Stress
  • Encourage your child to engage in stress-reducing activities such as mindfulness, deep breathing exercises, or yoga. Make time for fun and relaxation activities.
  • Doctor’s Visit
  • If your child is experiencing significant symptoms, it’s important to call and discuss them with their healthcare provider.

Dr. Jayagauri A/P Balakrishnan
Consultant Pediatrician
Columbia Asia Hospital - Petaling Jaya

MD (Russia), M Pediatric (UM)
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  This article first appeared in, 29 May 2023.
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