IBS and Diet in Children

IBS and Diet in Children

Irritable Bowel Syndrome (IBS) is a medical term used to describe a collection of gut symptoms. These symptoms include:

• Abdominal pain/discomfort, often relieved by going to the toilet
• Bloating
• Diarrhoea
• Constipation
• Wind
• Altered stool passage (straining, urgency, passage of mucus, incomplete evacuation)

Other symptoms that may be associated with IBS are tiredness, nausea, heartburn, indigestion, backache, needing to pass urine frequently, headaches, muscle pain, anxiety and depression. Symptoms vary from one individual to another and can be worse for some than others.

Diet, stress or life change can have an impact on symptoms. Sometimes mental triggers may also appear as anxiety, depression, fatigue or trouble concentrating.

There is no specific cause for IBS. Common risk factors are gastro-enteritis attack, traumatic or upsetting event, or courses of powerful antibiotics.

It is important to have a diagnosis of IBS confirmed. There are no tests for IBS but you can have tests to exclude other possible conditions such as Coeliac disease and inflammatory bowel disease.

There is no cure for IBS. The main goal of treatment is to ease symptoms and help your child get back to normal daily activities.

IBS symptoms can affect your child’s daily activities. You may need a plan to deal with issues such as diet, school, and emotional or mental health.
Dietary changes can often help IBS symptoms and sometimes simple changes are all that are needed.

Dietary changes
Try to:

• Eat 3 regular meals a day. Do not skip meals.
• Eating smaller frequent meals may ease symptoms.
• Identify and avoid trigger foods.
• Reduce intake of caffeine containing drinks.
• Reduce intake of fizzy drinks.
• Drink at least 8 cups of fluid per day.
• Cut down on high fat foods like processed or fast foods.
• Reduce dairy intake if your child can’t digest lactose. Consider using lactose free or calcium enriched plant milks.
• Choose fruit and vegetables that don’t exacerbate gas and bloating.
• Avoid hot spicy foods.

Lifestyle changes

• Don’t rush your meals. Sit down and enjoy your food.
• Allow time to chew and savour your food.
• Avoid eating late at night.
• Take time to relax.
• Take regular exercise – sports or physical activities. This can help regulate bowel movements but also relieve stress and anxiety.
• Get enough sleep.
• Keep a food, mood and symptom diary to help identify triggers.

Use the ‘Eatwell Guide’ to plan your meals

To get your 5 a day you could have dried fruit with your cereal, have fruit as a snack, add salad to your sandwiches and have two different vegetables with your evening meal.

Bread, rice, potatoes, pasta & other cereals should be the main source of energy in our diet.

• Include at least one starchy food at each meal.
• Choose wholegrain starchy foods as they contain more fibre and are slowly digested making you feel fuller for longer.
• Choose wholegrain cereals or oats for breakfast.
• Have wholemeal or granary bread for sandwiches.
• Include brown or basmati rice, wholewheat pasta, new potatoes in skins or jacket potatoes at mealtimes.

Milk & dairy foods are good sources of protein and vitamins and minerals such as calcium which helps keep your bones healthy.

• Aim to include 3 portions per day. 1 portion =
  • 1/3 pint (200ml) milk
  • 1 small pot of yoghurt/fromage frais
  • 1oz (25g) cheese.
• Dairy foods can be high in fat. To reduce your fat intake change from full cream to semi-skimmed or skimmed milks. Try reduced-fat hard cheeses, low fat cheese spreads or cottage cheese. Look for diet or light yoghurts and lower fat ice cream.

Foods high in fat & sugar

• Limit cakes, pastries, sweets, chocolate, biscuits, crisps, cream and ice cream.
• Use all fats including margarine, butter, spreads and cooking oils sparingly. The best type of fat to include in your diet is monounsaturated fat. Good sources are oils and spreads produced from olive oil and rapeseed oil.
• Look for low fat alternatives such as low-fat spreads, mayonnaises and oil free dressings.
• Use low fat cooking methods such as grilling, steaming and poaching.
• Look for sugar free drinks and reduce the amount of sugar you use in drinks, on cereals and in baking.

If symptoms include wind and bloating

• Reduce intake of gas producing foods e.g. beans and pulses, brussels sprouts, cauliflower, onions, garlic, chewing gum.
• Cut down on fizzy carbonated drinks.
• Avoid products containing a sweetener such as sorbitol, xylitol, and mannitol.
• You may find it helpful to eat soluble fibre such as oats and linseeds.
• Limit fruit to no more than 3 portions a day.
• Herbal remedies such as peppermint tea or drops can help alleviate symptoms of wind.

If symptoms include constipation

• Try to gradually increase your fibre intake. Rich sources of fibre include wholegrains, oats, vegetables, fruit, beans and pulses. They help to soften stools and make it easier to pass.
• It is important to drink enough fluid. Try to have 6-8 glasses of uncaffeinated drinks per day to improve stool frequency and decrease the need for laxatives.
• Avoid eating extra wheat bran.
• Try including seeds such as linseeds or chia seeds which can be sprinkled onto cereals and puddings.
• Speak with your GP or pharmacist about medicines that can help e.g. laxatives.
• Identify a bowel routine e.g. find a time/place where you are comfortable to go to the toilet, respond to your bodies natural pattern.

If symptoms include diarrhoea

• Replace lost fluids by drinking plenty of uncaffeinated drinks.
• Reduce caffeine intake from tea, coffee, soft drinks and energy drinks.
• Cut down on high fibre foods like wholegrain foods, fruit, vegetables, nuts and seeds.
• Avoid sugar free mints, chewing gum, flavoured water and other low calorie products containing sorbitol, mannitol, or xylitol.
• Consider lactose free dairy products or plant based alternatives.
• Try reducing fruit to a maximum of 3 portions per day

Resistant Starches

These are starches that are resistant to digestion in the gut. Therefore, they reach the colon intact and are fermented by the bacteria in the gut producing gas and waste products leading to symptoms of bloating, wind and diarrhoea.

Reduce foods that contain resistant starches such as:

• Processed foods such as crisps, oven chips, pizza, biscuit.
• Ready meals, cold pasta, potato salads
• Partially baked bread e.g. garlic bread
• Dried pasta
• Wholegrains, pulses, sweetcorn, muesli.
• Pastry

Probiotics

• Probiotics can help to balance the gut bacteria. This can help with digestion and improve symptoms of wind, bloating and diarrhoea.
• There are a number of probiotic products available, including yoghurts, fermented milk drinks such as kefir and supplements such as tablets, capsules or sachets.
• If using a probiotic supplement, try one at a time and take it daily for at least 4 weeks to see if symptoms improve, if not try a different brand.

It is possible to eat a healthy and varied diet while restricting foods that may upset your child’s gut. While there’s no cure for IBS, there are many methods to help your child manage their symptoms and maintain a healthy lifestyle.

Alternative therapies

If dietary changes and medication have not helped your child’s symptoms, you may find it useful to try counselling, hypnotherapy, or cognitive behavioural therapy (CBT). This can help if stress or anxiety is triggering the symptoms. It can also help them cope with their condition better.

Give the bowels time to adjust to any changes. If symptoms persist after following general lifestyle and dietary advice, reintroduce the foods that you have cut out.

Low FODMAP Diet

FODMAP stands for Fermentable Oligo Di Monosaccharides And Polyols. A low FODMAP diet involves avoiding foods that are not easily broken down by the gut, such as some types of:

• Fruit and vegetables
• Milk (lactose)
• Wheat products (gluten)
• Sweets (sorbitol)

FODMAP can be a very restrictive diet and is not used as first line treatment. There are concerns that in growing children growth and nutrition may be affected and there is also limited evidence of its benefits in children. However, it may be helpful for some children to trial exclusions of single FODMAP foods and your dietitian will discuss this with you.

Further help and support
The IBS Network www.theibsnetwork.org
GutsUK
Self Help IBS group
BDA food fact sheet: Irritable Bowel Syndrome and Diet
You can also watch IBS Webinars on the NHS Patient Webinars website

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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