Irritable Bowel Syndrome in Children When Should You Be Worried and How to Act

Irritable bowel syndrome (IBS) in children is a concern for any parent, especially when a child shows symptoms like abdominal pain, bloating, or changes in bowel habits. Knowing the early signs and causes can help you act quickly and protect your child from potential complications. In this Dalily Medical article, we’ll explore the symptoms of IBS in children, its main causes, and effective treatments—both medical and psychological—in a simple and easy-to-understand way for all parents.

Is irritable bowel syndrome (IBS) a chronic condition in children?
Yes, IBS is a chronic condition, but it’s not dangerous and can usually be managed easily by adjusting lifestyle habits and following the appropriate treatment.
Can a child completely recover from IBS?
Not in the literal sense of a full cure, but a child can live a normal life without symptoms if they stick to a proper diet, follow treatment, and maintain regular check-ups with the doctor.
Does IBS affect growth or weight?
If the child doesn’t eat well or experiences persistent symptoms, their weight and growth may be affected. That’s why ongoing monitoring by a pediatrician is important if symptoms recur.
Does stress worsen IBS symptoms?
Absolutely. Stress and psychological pressure are among the main factors that can worsen IBS symptoms, especially during school age or exam periods.

What is irritable bowel syndrome (IBS) in children?
IBS is a chronic and long-term disorder that affects the intestines in children. With IBS, the colon appears normal, but the child experiences abdominal pain and changes in bowel habits, such as constipation or diarrhea.

Types of IBS in children:

IBS with constipation (IBS-C):
The child experiences chronic constipation with abdominal pain.
Stools are usually hard or difficult to pass.
IBS with diarrhea (IBS-D):
The child experiences frequent diarrhea with abdominal pain.
Stools are usually loose or watery.
Mixed IBS (IBS-M):
The child alternates between constipation and diarrhea with intermittent abdominal pain.
Unclassified IBS (IBS-U):
Symptoms are present, but the child cannot be clearly categorized into the previous types.

Important notes for parents:
Symptoms often worsen with stress or dietary changes.
Regular follow-up with a doctor is necessary to determine the type of IBS and develop an appropriate treatment plan.

Children at risk of developing IBS:
Children who are more likely to develop IBS usually have certain risk factors, including:

✅ 1. Children with a family history:
If a family member (such as the mother or father) has IBS, the child is more likely to develop it due to genetic factors.

✅ 2. Children exposed to stress or anxiety:
Continuous anxiety, school problems, or tension at home can increase a child’s bowel sensitivity.

✅ 3. Children who had gastrointestinal infections:
Some children develop IBS after a severe stomach or intestinal infection, such as food poisoning or gastroenteritis.

✅ 4. Children with food sensitivities or intolerances:
For example, lactose (milk sugar) or gluten (in wheat), which can trigger symptoms similar to IBS.

✅ 5. Girls more than boys:
Studies indicate that girls may be more prone to IBS during childhood or adolescence.

✅ 6. Children with a sedentary lifestyle:
Lack of physical activity, insufficient exercise, and not drinking enough water can worsen IBS symptoms.

Causes of IBS in children

The exact cause isn’t always clear, but it usually results from a combination of psychological and physical factors. The most common causes include:

Stress and psychological pressure:
Anxiety or fear due to school, family issues, or bullying can cause abdominal pain and changes in bowel habits, as the digestive system is directly affected by the child’s mental state.
Irregular diet:
Fried, fatty, or preservative-rich foods can worsen symptoms.
Examples: dairy products (if the child is lactose intolerant), legumes, caffeine from chocolate or soda.
Intestinal sensitivity or abnormal bowel movement:
Fast or slow bowel movements can cause diarrhea or constipation, and the digestive system may be more sensitive to certain foods or changes.
Impaired brain-gut communication:
The “brain-gut axis” coordinates the nervous and digestive systems, and any disruption may trigger IBS symptoms.
Genetic factors or family history:
Having a family member with IBS increases the child’s likelihood of developing it.
Post-gastrointestinal infection:
Some children develop IBS symptoms after recovering from a stomach or intestinal infection caused by bacteria or viruses.

Causes of microscopic colitis in children

The exact cause of microscopic colitis in children is unknown, but several factors may contribute:

Medications: Some drugs can irritate the colon lining.
Bacteria: Certain bacteria produce toxins that irritate the colon.
Viruses: Some viral infections can cause similar irritation.
Autoimmune diseases: Coexisting immune disorders may contribute to microscopic colitis.
Bile acid malabsorption: Poor absorption of bile acids can irritate the colon lining.

Causes of allergic colitis in children

Allergic colitis is often related to immune system changes:

Maternal immune changes during pregnancy can affect the child.
Immature immune system in the child makes them more prone to allergies.
Genetic factors: Family history of allergies (food allergies, asthma, or environmental allergies) increases the child’s risk.
Variation in symptom severity: It is unclear why one child is affected and another is not; symptom severity varies from child to child.

How is IBS diagnosed in children?

Diagnosing IBS in children relies on medical history, symptoms, and excluding other causes. Healthcare providers usually follow these steps:

Medical history and physical examination:

Ask about symptoms, onset, and severity.
Conduct a thorough physical exam to rule out other health problems.

Symptoms that may indicate other causes:
If any of the following appear, the doctor may order additional tests:

Unexplained weight loss
Frequent vomiting
Fever without cause
Bloody diarrhea
Delayed growth
Enlarged liver

Laboratory tests:

Blood tests: Check for anemia, infection, or inflammation.
Urine analysis and culture: Detect urinary tract infections.
Stool sample: Check for bacteria, parasites, or inflammation.
Fecal occult blood test: Detect hidden blood in the stool.
Breath tests: Detect difficulties digesting sugars like lactose and fructose, e.g., lactose hydrogen breath test.

Imaging tests:

Abdominal X-ray: Gives an overview of internal organ structure.
Abdominal ultrasound: Shows organs in action.
Sometimes MRI or CT scans: To evaluate conditions that mimic IBS.

Gastrointestinal endoscopy:

Upper endoscopy (EGD): Examines the esophagus, stomach, and duodenum, and allows tissue samples for testing.

Colonoscopy: Used to examine the large intestine and take tissue samples if necessary.

Important Note:
IBS is usually diagnosed after excluding other organic causes. Therefore, regular follow-up with the doctor is very important to ensure an accurate diagnosis and to create an appropriate treatment plan for the child.

When should you contact your child’s healthcare provider?

It’s important to see the doctor immediately if any of the following signs appear:

Severe or persistent abdominal pain:
Frequent cramps or abdominal pain that does not go away.
Abnormal abdominal bloating:
A visibly swollen or unusual-looking belly.
Severe or persistent diarrhea:
Especially if accompanied by blood or mucus, or if it lasts more than two days.
Persistent and painful constipation:
Difficulty passing stool or pain during bowel movements.
Weight loss or poor growth:
If the child is not gaining weight or starts losing weight without a clear reason.
Frequent vomiting or vomiting with blood:
Could indicate a more serious gastrointestinal problem.
Fever with abdominal symptoms:
High fever accompanied by cramps or severe diarrhea.
Lethargy or unresponsiveness:
Child is not active or does not respond normally to their environment.

Difference between IBS and inflammatory colitis in children

Feature	Irritable Bowel Syndrome (IBS)	Inflammatory Colitis
Cause	Dysfunction in bowel movement and function	Chronic inflammation due to immune disorders (e.g., Crohn’s or ulcerative colitis)
Common age	Usually school age or adolescence	Can occur at any age, including childhood
Main symptoms	Cramps, bloating, alternating constipation or diarrhea	Persistent diarrhea, blood in stool, severe abdominal pain
Blood in stool	Very rare	Very common
Weight loss	Rare	Common and may be noticeable
Fever	Uncommon	Common during inflammatory episodes
Blood tests	Usually normal	Show inflammation, elevated WBC and CRP
Required tests	Stool test, sometimes endoscopy if needed	Colonoscopy, biopsies, comprehensive blood and stool tests
Treatment	Diet modification, antispasmodic medications	Immune-modifying drugs, corticosteroids, sometimes surgery
Improvement over time	Possible with dietary and stress management	Chronic, requires ongoing medical follow-up
Impact on growth	Rare	Can affect growth and height if not properly treated

Types of colitis in children

Ulcerative Colitis:
Usually affects the rectum and may extend to other parts of the colon.
Symptoms: Frequent diarrhea, blood in stool, abdominal pain, weight loss, sometimes fever.
Crohn’s Disease:
Can affect any part of the digestive tract, from mouth to anus.
Symptoms: Diarrhea, abdominal pain, weight loss, mouth ulcers, poor growth, elevated inflammation markers in blood.
Toxic / Infectious Colitis:
Caused by bacterial, viral, or parasitic infections.
Symptoms: Sudden diarrhea, blood or mucus in stool, fever, severe abdominal pain. May require antibiotics.
Ischemic Colitis (rare in children):
Occurs due to reduced blood flow to the colon.
Symptoms: Severe abdominal pain, blood in stool, may require urgent medical intervention.

Medications for IBS in children

Antispasmodics:
Used to relieve bowel cramps and abdominal pain caused by IBS.
Examples: Mebeverine or Dicyclomine (as prescribed by the doctor).

Laxatives / Stool Softeners

Used if the child suffers from frequent constipation.
Examples: Polyethylene Glycol (PEG 3350) or Lactulose.

Antidiarrheals

Used cautiously if the child has severe or frequent diarrhea.
Example: Loperamide – only under doctor supervision.

Probiotics

Help balance beneficial gut bacteria and reduce some IBS symptoms.
Safe examples for children: Bifidobacterium or Lactobacillus.

Pain Relievers

For mild pain, Acetaminophen (Paracetamol) can be used according to the child’s weight.
Avoid Ibuprofen or strong anti-inflammatory drugs without doctor advice.

Important Tips for Parents

Never give any medication without consulting a pediatrician.
Monitoring and recording symptoms help the doctor adjust treatment appropriately.
Focus on a healthy diet, adequate water intake, and encouraging physical activity to significantly reduce IBS symptoms.

Living with IBS Symptoms in Children

Managing IBS in children can be challenging, but with proper care, the child can live a normal and comfortable life. Key daily steps include:

1. Dietary Modification

Avoid trigger foods: legumes, fried foods, spicy foods, caffeine (for older children).
Serve small, frequent meals instead of large heavy ones.
Gradually introduce fiber to improve bowel movements: vegetables, fruits, oats.
Monitor for food sensitivities: remove foods that trigger symptoms under medical guidance.

2. Reducing Psychological Stress

Stress and anxiety can worsen IBS symptoms. Provide a calm environment at home and school.
Consider Cognitive Behavioral Therapy (CBT) or speaking with a child psychologist.
Breathing exercises and relaxation techniques help calm the belly and reduce cramps.

3. Regular Follow-Up with the Doctor

The doctor may prescribe mild medications to reduce cramps or bloating as needed.
Sometimes, probiotics are recommended to improve healthy gut bacteria.

4. Encourage Physical Activity

Physical activity helps reduce stress and regulate bowel movements.
Walking, swimming, or active games that the child enjoys are beneficial.

5. Daily Symptom Tracking

Keep a diary of symptoms, food intake, and stress levels to identify triggers.
Share this diary with the doctor to determine the most suitable treatment plan.

Treatment Approach for IBS in Children

The treatment focuses on reducing symptoms and improving the child’s quality of life, usually through three main approaches:

1. Dietary Modifications

Avoid trigger foods: caffeine, high-fat foods, spicy foods, carbonated drinks.
Reduce dairy if lactose intolerance is present.
Increase fiber: fruits, vegetables, oats, especially if constipation is the main symptom.
FODMAP diet: sometimes recommended to reduce foods with hard-to-digest sugars like onions, garlic, and legumes.

2. Behavioral Therapy and Psychological Support

Provide a psychologically comfortable environment to reduce anxiety.
CBT sessions for children who are anxious or fearful of symptoms.
Breathing and relaxation exercises to ease cramps and abdominal pain.

3. Medications (Prescription Only)

Antispasmodics: such as Hyoscine or Mebeverine, under doctor supervision.
Antidiarrheals: such as Loperamide (rarely, in specific pediatric doses).
Mild laxatives: for constipation cases.
Low-dose antidepressants: in certain older children with chronic pain and anxiety.

Psychological Treatments for IBS in Children

Psychological care is a crucial part of IBS management because the condition is closely linked to stress the child experiences at home or school. Key approaches include:

1. Cognitive Behavioral Therapy (CBT)

One of the most effective psychological treatments for children with IBS.
Helps the child:
- Understand the link between anxiety and physical symptoms.
- Change negative thoughts about pain.
- Learn new techniques to manage stress and anxiety.

2. Relaxation and Breathing Exercises

Reduce abdominal muscle tension and calm the digestive system. Examples:
- Deep breathing.
- Progressive muscle relaxation.
- Simple meditation exercises for children.

3. Supportive Counseling

Beneficial for children facing issues like bullying, loss, or family problems.
Helps children express emotions in a healthy way.

4. Family Involvement

Parents should understand the condition and learn how to support their child psychologically.
Reduce pressure in daily routines, school, and home life.