One of the most challenging experiences for parents is to see their child in pain. If your child has been diagnosed with irritable bowel syndrome (IBS) or functional abdominal pain (FAP), you may be experiencing feelings of powerlessness, frustration and confusion.
Being on the front lines, you know that IBS in children is no minor matter. Research has shown that kids with IBS experience low quality of life, miss a lot of school and have to attend numerous medical appointments. The impact of IBS in one child can affect the entire family dynamic. Luckily, for many children, the disorder will improve with time and minor interventions. Unfortunately, for others, digestive difficulties may persist into adulthood.
It has often been said that children don't come with instruction manuals. This is even more true when it comes to manuals for helping parents deal with the challenges of a functional gastrointestinal disorder like IBS. This article has been written with the intention of providing you with some guidelines to follow as you work with your child and your child's doctor to help ease your child's distress.
1. Educate Yourself
In order to be of optimal help to your child, you need to have a good understanding of what is causing the problem. IBS is unlike other health problems in that there are no clear-cut diagnostic tests or laboratory findings that pinpoint what is going wrong. Although a direct cause may not be identified, problems with visceral hypersensitivity and colon motility seem to be at play. There are several theories as to what may be behind these dysfunctions, so it may be a good idea for you to acquaint yourself with those theories to better understand what could be behind your child's symptoms:
2. Establish a Good Working Relationship with Your Child's Medical Team
Adult IBS patients who feel positive about their relationship with their child's doctor have a better treatment outcome. You'll feel much more confident about how to handle your child's IBS if you're working with doctors that you trust and respect. Be sure that your doctors take the time to listen to your concerns and, most importantly, take them seriously. If you feel that a doctor is dismissing or minimizing your child's distress, this is not the right doctor for your child. If a doctor's advice does not sit well with you, discuss your concerns with the doctor, or get a second opinion. No one knows your child as well as you do.
Be sure to set reasonable expectations: IBS is not a health problem that your doctor can quickly cure. Instead, look for gradual symptom improvement and an increased ability for your child to engage in her regular activities.
3. Teach Your Child About Digestion
It may help your child to cope better with what's happening to her body if she has a better understanding of the process of digestion. For small children, simple pictures are best, while older children and teenagers can benefit from a more detailed discussion. Helping your child to know how her body is supposed to be working will help her cooperate with, and benefit from, treatments designed to ease her symptoms. The following articles may be of help:
4. Help Your Child to Establish Good Bowel Habits
Young children seem to love to avoid things, whether it's taking a bath, brushing their teeth or taking time out to have a bowel movement. Older children may be reluctant to use public restrooms, or to not wake up early enough in the morning to make the time for a toilet trip. Now that you have explained to them the process of digestion, engage them in helping their bodies to try to find their way back to normalcy.
Children whose primary symptom is constipation should be taught to "tune in" to indications that their body is ready for a bowel movement. They may also benefit from bowel retraining:
Children who are experiencing bouts of urgent diarrhea can be taught relaxation skills to help reduce anxiety that may be strengthening colon contractions and increasing the sense of urgency. Older children may benefit from the information in the following two articles:
5. Validate Their Pain
Just because nothing shows up on a CAT scan doesn't mean that the pain your child is experiencing isn't real. Any attempt to minimize his pain will probably backfire on you, as it will increase your child's anxiety that you're not paying attention to the fact that something is wrong. The more anxious a person is, the more the pain sensation is enhanced.
When your child is in pain, offer support and comfort. Encourage him to use self-soothing strategies. For small children, it may mean cuddling up with a favorite stuffed animal or blanket. Older children may find that listening to soothing music or the distraction of interacting with their friends on social media helps them to get through a bout of abdominal pain.
You can enhance your child's sense of self-efficacy, and possibly reduce pain-enhancing anxiety, by asking them to brainstorm self-soothing ideas. For small children, a wonderful technique is to talk directly to the favorite stuffed animal. For example, ask "Does Teddy have any ideas as to what will help you feel better?" Older children can of course be asked directly for their ideas. My tips can be found here:
6. Learn About the Relationship of IBS Symptoms to Diet
Although it seems to defy logic, research has not shown much of an impact of dietary changes on IBS symptoms in children. This seems to be particularly true when it comes to the symptom of stomach pain. With that in mind, there are some general guidelines to keep in mind:
Have your child avoid the following:
- Artificial sweeteners that end in "-ol"
- Fatty foods
- Gassy foods
If your child's symptom picture includes bouts of diarrhea, encourage him to eat small meals throughout the day to avoid strengthening intestinal cramps. If your child is more likely to be dealing with constipation, encourage him to eat a large meal — particularly in the morning — to help initiate a bowel movement.
If necessary, increase your child's fiber intake, but do it very slowly. To figure out how many grams of fiber a day your child should be consuming, simply add five to his age. Fiber helps to both bulk up the stool (good for diarrhea) and to soften the stool (good for constipation). However, many sources of fiber can cause gas and bloating, which may worsen your child's symptoms. Slowly increasing the fiber content of your child's diet may help his body to adjust without excess gassiness.
Before making any major changes to your child's diet, be sure to discuss your plans with your child's physician, who is in a position to best know how any changes will affect your child's health.
7. Look Into Mind-Body Treatments
Research has shown that some forms of psychotherapeutic treatment can have a positive effect on IBS symptoms. If your child is experiencing episodes of abdominal pain, he may benefit from hypnotherapy. If your child experiences a lot of anxiety, and you think that this anxiety is making his symptoms worse, he might benefit from cognitive behavioral therapy (CBT). These articles will give you more information on these types of treatment.
- Hypnotherapy for IBS
- Hypnotherapy for Abdominal Pain in Children
- Cognitive Behavioral Therapy for IBS
8. Work with School Officials
One of the most frustrating and disconcerting aspects of IBS in kids is when it interferes with their ability to attend school. On the one hand, it's tempting to worry that the child is exaggerating her symptoms to avoid school. On the other hand, it can be terribly worrisome to think about the impact that missing so much school will have on your child's overall education. As for the first, my recommendation is to listen to your child to determine whether or not he is able to get to school. For many children, symptoms are worse in the morning, so sometimes a late start may be what is needed. In other cases, children may need home instruction. It's therefore essential to try to work with the school to make sure that your child's educational needs are being met. Here are some articles that will help you understand what your rights are:
- IBS and School: 504 Plan
- The Americans With Disabilities Act and IBS
- Readers Share: Using a 504 Plan
This article is appropriate for older children and adolescents:
9. Don't Overlook Your Other Children
A health problem doesn't just affect the person who has the diagnosis. The lives of siblings are also impacted: the "sick" child is perceived as getting more attention, family plans are cancelled, certain foods can't be served, etc. Feelings of resentment may develop in healthy siblings. In some cases, the healthy sibling may start to "act out" in an effort to shift the center of attention.
Although we all know how busy life can be, it's important to try to find "alone time" with your other children. When you have them alone, encourage them to verbalize their feelings about their brother or sister's IBS problem. Let them know that any negative feelings that they have are normal and understandable. It's amazing how much better people feel when their feelings are validated.
Many children have a hard time putting their feelings into words. For small children, you can enlist the help of their favorite stuffed animal. Often a child can tell you that, "Teddy hates my brother," but know that she probably shouldn't say that herself! For older children, their feelings may be validated simply by your putting them into words, e.g., "You may be upset about what is happening with your sister. You may be resentful of the attention that she is getting or bummed when we have to cancel our family plans. These feelings are normal and understandable".
Children of all ages can benefit from being asked for their ideas about solutions, e.g. "What ideas do you have for family fun that we can do close to home?" or "Do you have any thoughts as to what might make your brother/sister feel better?" Again, for young children, including their security object in the conversation can help to generate ideas. Whatever works. The point is to make the healthy siblings feel that they're still an important part of the family. And remember, all of us are so much better at cooperating with a plan when we've helped to come up with it!
10. Find Balance for Yourself, Your Child and Your Family
Having a sick child is very, very stressful. Make sure that you're not neglecting your own needs as you struggle to help your child deal with her IBS. Find ways to "re-charge your batteries" whenever possible. Remember that the better care you take of yourself, the more you will have to give to others. You can find many wonderful stress management strategies on Elizabeth Scott's Stress Management site.
With every dark cloud, there is a silver lining. Perhaps the silver lining of the dark cloud that is your child's IBS is that it forces your family to slow down and spend time together — a rare luxury in our very busy culture. Find low-stress activities that your whole family can enjoy, such as reading books together, watching movies, or working on an old-fashioned jigsaw puzzle. Modern technology also offers a ton of ways to keep children entertained at home. Look for video games or apps that the whole family can enjoy together. Let IBS offer an opportunity for all family members to know that they are loved, and to make sure that everyone's needs are nurtured.
Essential Reading from Dr. Bolen, Your IBS Expert:
Chiou E & Nurko S. "Management of functional abdominal pain and irritable bowel syndrome in children and adolescents." Expert Review of Gastroenterology & Hepatology 2010 4:293-304.
DISCLAIMER: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.