Paediatric irritable bowel syndrome (IBS)
What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome (IBS) is a functional abdominal pain disorder characterised by a group of symptoms that include recurrent abdominal pain and change in stool frequency/form, without biochemical or structural disease.[1] IBS and other functional abdominal pain (FAP) disorders have a worldwide prevalence of 13.5% in children aged 4–18 years. [2,3] They have been shown to negatively affect quality of life in children and are associated with psychosocial burden and a reduction in school participation and social activities.[8] Symptoms of IBS often follow a pattern of flare-ups and periods of improvement that can be influenced by stress, diet or illness. [1]
Symptoms and diagnosis
The Rome IV criteria has been adopted in recent paediatric guidelines as a diagnostic tool for IBS in children. It defines irritable bowel syndrome as:
'Abdominal pain occurring at least four days per month, over a minimum of two months, associated with defecation or a change in stool frequency or form.' [1]
Typical symptoms include:
Constipation
Diarrhoea
Bloating
Cramping abdominal pain
IBS is often differentiated into three categories:
IBS Constipation (IBS-C)
IBS Diarrhoea (IBS-D)
IBS Mixed
Basic investigations are often carried out to rule out alternative causes of gastrointestinal symptoms before confirming a diagnosis of IBS. [1]
This includes:
Blood tests
Inflammatory markers
Coeliac serology
Full blood count and nutritional bloods
Stool sample
To check for infection
To check for raised faecal calprotectin
If there are no ‘red flag’ symptoms – such as weight loss, family history of inflammatory bowel disease (IBD) or coeliac disease (CD), gastrointestinal bleeding or nocturnal stooling – clinicians may diagnose IBS without further investigations.
Red flag symptoms
Weight loss
Family history of IBD or CD
Gastrointestinal bleeding
Nocturnal stooling
Red flag symptoms matter, as they may suggest an underlying gastrointestinal condition.
Key considerations during dietetic assessment
Clinical
Gather clinical history, including:
• Past medical history
• Family history of conditions such as inflammatory bowel disease (IBD) and coeliac disease
• Allergies or intolerances
• Medications; drugs such as laxatives, proton pump inhibitors or antispasmodics can influence gastrointestinal symptoms
• Vitamins/supplements
Dietary
A 3–7 day diet history, including weekdays and weekends, can help identify patterns and potential triggers. [1,4
Consider:
• Restrictive patterns
• Fibre intake
• Fluid intake
• Meal patterns
• Ultra processed foods
• Caffeine
• Fizzy drinks
Gastrointestinal symptoms
Assess stool frequency and form using the Bristol Stool Chart, identify diarrhoea or constipation patterns, urgency, and pain characteristics (location, timing, triggers).
Environmental
Consider the psychosocial impact of symptoms, such as school absence, avoidance of social activities, difficult mealtimes, and disordered eating behaviours.[8] These issues can affect the whole family and may worsen parental anxiety.
First line dietary advice
First line dietary advice should be implemented before considering restrictive diets such as the low-FODMAP. [1,4] Recommendations include:
Regular meal pattern (3 meals + 1–2 snacks)
Avoid very large meals and eating late at night
Limit fizzy drinks, fruit juices and caffeine
Limit fatty or fried foods
No more than 3 portions of fresh fruit per day – may need to be spread out throughout the day
Fibre
Fibre is an important nutrient that children with IBS still need to include in their diet. [1] For children with constipation, gradually increase fibre in their diet by including foods such as:
Fruits
(kiwi, apples, pears, bananas)
Vegetables
(sweet potato, carrots, peas, broccoli)
Wholegrains
(brown rice, oats)
Beans/pulses
(kidney beans, lentils, chickpeas)
Avoid sudden increases in fibre, as this can lead to excess bloating and gas.
For children with diarrhoea, high fibre foods may worsen symptoms, so they may need to limit these and choose lower fibre options such as white bread and pasta.
Consider the difference between soluble and insoluble fibre. Soluble fibre found in foods such as bananas, root vegetables and oats may be better tolerated than insoluble fibre foods, such as wholegrains and leafy greens.
Involvement from other clinicians, such as paediatricians or paediatric gastroenterologists, is important as some children will require medications such as laxatives or antidiarrheal agents.
Food restrictions
A food and symptom diary can be a useful way to help identify any trigger foods. [1,4]
For example, if a child seems to be having a reaction to lactose, you could consider a 2-4 week exclusion with a re-challenge to confirm. Ensure nutritionally adequate alternatives are offered.
A gluten-free diet is not recommended as routine treatment for children with IBS, unless there are clear wheat-related symptoms. [9]
Probiotics
Probiotics are often recommended for children with IBS, although the efficacy is uncertain as evidence is mixed and strain-specific. [4,5] They should be recommended as an optional, time-limited trial (4-8 weeks) rather than first line advice. [1,4]
Lifestyle
It is important to think of IBS in a holistic way and consider the impact of non-dietary triggers, such as stress. [1,4] Encourage mealtimes to be relaxed and for children to chew food well. Encourage children to take time to relax, be physically active, get adequate sleep and consider referrals to psychology if you feel they may need additional support. [1,4] Relaxation techniques such as yoga, mindfulness and breathing techniques may be beneficial.
Low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) Diet
FODMAPs are short-chain carbohydrates that are poorly absorbed in the intestine, then fermented by gut bacteria, producing gas and drawing water into the bowel.[5] This can cause bloating, pain, wind and changes in stool consistency.
A low-FODMAP diet can be recommended in paediatrics, but the effectiveness is less established than in adults.[5,6] If a child is 8-9 years old or older (and developmentally able) and is still symptomatic, despite following first-line advice, the low-FODMAP diet can be considered. It is important to ensure they have no red-flag symptoms or a nutritional or psychological risk.[10]
Phases
Short restriction
· 2-4 weeks following the low-FODMAP diet
· Does not need to be a ‘perfect’ restriction
· Consider appropriate swaps to ensure adequate nutritional intake and growth, eg milk to lactose-free milk
Re-introduction
· Introduce the restricted FODMAP foods one at a time
· It is useful for parents/children to keep a food diary to identify trigger foods
Only limit trigger foods that are clearly identified and ensure adequate growth and nutritional monitoring throughout the process.
Last updated: 22 March 2026
Holly is a Paediatric Dietitian specialising in gastroenterology and intestinal failure, with over six years of clinical experience. She currently works at the Royal Manchester Children’s Hospital (MFT) and runs a private practice.
Molly Lovell RD
Highly Specialist Paediatric Dietitian in Gastroenterology
References:
Groen, J., Gordon, M., Chogle, A., Benninga, M., Borlack, R., Borrelli, O., ... & Saps, M. (2025). ESPGHAN/NASPGHAN guidelines for treatment of irritable bowel syndrome and functional abdominal pain‐not otherwise specified in children aged 4–18 years. Journal of Pediatric Gastroenterology and Nutrition, 81(2), 442–471.
Korterink, J. J., Diederen, K., Benninga, M. A., & Tabbers, M. M. (2015). Epidemiology of pediatric functional abdominal pain disorders: A meta-analysis. PLOS ONE, 10(5), e0126982.
Lewis, M. L., Palsson, O. S., Whitehead, W. E., & van Tilburg, M. A. (2016). Prevalence of functional gastrointestinal disorders in children and adolescents. The Journal of Pediatrics, 177, 39–43.
Gordon, M., Groen, J., Sinopoulou, V., Chogle, A., Di Lorenzo, C., Saps, M., ... & Benninga, M. A. (2025). European and North American guidelines for treating irritable bowel syndrome and functional abdominal pain in childhood: A guide for health-care professionals. The Lancet Child & Adolescent Health, 9(11), 808–816.
Morariu, I. D., Avasilcai, L., Vieriu, M., Lupu, V. V., Morariu, B. A., Lupu, A., ... & Trandafir, L. (2023). Effects of a low-FODMAP diet on irritable bowel syndrome in both children and adults—A narrative review. Nutrients, 15(10), 2295.
Chumpitazi, B. P., Cope, J. L., Hollister, E. B., Tsai, C. M., McMeans, A. R., Luna, R. A., ... & Shulman, R. J. (2015). Randomised clinical trial: Gut microbiome biomarkers are associated with clinical response to a low FODMAP diet in children with the irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 42(4), 418–427.
Nybacka, S., Törnblom, H., Josefsson, A., Hreinsson, J. P., Böhn, L., Frändemark, Å., ... & Simrén, M. (2024). A low FODMAP diet plus traditional dietary advice versus a low-carbohydrate diet versus pharmacological treatment in irritable bowel syndrome (CARIBS): A single-centre, single-blind, randomised controlled trial. The Lancet Gastroenterology & Hepatology, 9(6), 507–520.
Tersteeg, S. M., & Borowitz, S. M. (2024). School absenteeism as a predictor of functional gastrointestinal disorders in children. Frontiers in Pediatrics, 12, 1503783.
Cristofori, F., Tripaldi, M., Lorusso, G., Indrio, F., Rutigliano, V., Piscitelli, D., ... & Francavilla, R. (2021). Functional abdominal pain disorders and constipation in children on gluten-free diet. Clinical Gastroenterology and Hepatology, 19(12), 2551–2558.
Rhys-Jones, D. (2023, June 20). The low FODMAP diet in children – are we there yet? Monash University. https://www.monashfodmap.com/blog/the-low-fodmap-diet-in-children-are-we-there-yet/
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