Irritable Bowel Syndrome (IBS)
A Disorder of Gut–Brain Interaction

What is IBS?

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal condition—now classified as a disorder of gut–brain interaction.

In IBS, the nerves and muscles of the intestines are more sensitive and reactive. Signals between the brain and gut become misaligned, which can change how the intestines move and how pain is felt.

IBS does not cause damage to the intestines, but it can significantly affect daily life and comfort.

Who is affected?

• IBS can occur at any age.
• In pediatrics, it often starts in school-age children or teens.
• It may run in families and is more common after a stomach infection, during times of stress, or alongside anxiety/depression.
• Girls are slightly more likely to have IBS than boys.

Typical symptoms

Symptoms vary from person to person and can come and go. Common patterns include:
• Abdominal pain or cramping that improves or worsens after a bowel movement
• Changes in bowel habits: constipation, diarrhea, or alternating between both
• Bloating, gas, and a sense of incomplete emptying
• Nausea or decreased appetite during flares
• Symptoms often worsen with stress, poor sleep, or certain foods

Red flags that suggest other conditions: persistent fever, weight loss, blood in the stool, nighttime symptoms that wake the child, delayed growth, or ongoing vomiting.

How is IBS diagnosed? (workup to rule out other disease)

IBS is a clinical diagnosis—based on symptoms and a normal exam—after ruling out other causes.

Your provider may order limited testing to exclude conditions such as celiac disease or inflammatory bowel disease (IBD). Possible tests include:
• Blood work (complete blood count, celiac screening) and stool tests (e.g., calprotectin)
• Depending on symptoms, a trial of acid-reduction or constipation therapy
• Imaging or breath tests are rarely needed

An endoscopy is not always required. It is typically reserved for children with red flags or abnormal labs suggesting another condition.

Treatment pillars

There is no single medication that “cures” IBS, but many strategies reduce symptoms and improve quality of life. We focus on three pillars:

Nutrition
• Aim for less processed foods and balanced meals
• Identify and avoid food triggers; some families find benefit with dairy-free or gluten-free approaches
• Consider a short-term low-FODMAP diet with dietitian support, then reintroduce foods to find personal triggers

Sleep & daily rhythm
• Goal: 8–10 hours of quality sleep per night for children and teens
• Keep a consistent sleep schedule; add regular daily physical activity

Mental health & stress management
• Stress and emotional health directly affect IBS symptoms
• Counseling, treatment of anxiety or depression, and healthy coping strategies can improve gut symptoms

Medications that can help symptoms

While no medicine cures IBS, several can target specific symptoms (your provider will individualize dosing for age/weight):

• Antispasmodics: dicyclomine (Bentyl), hyoscyamine (Levsin) for cramping
• Low-dose tricyclic antidepressants: amitriptyline at bedtime for pain and sleep; often helpful in IBS with pain and diarrhea
• SSRIs/SNRIs: citalopram (SSRI) or duloxetine (SNRI) may help pain modulation and treat coexisting anxiety/depression
• Bowel habit support:
– Constipation: polyethylene glycol (Miralax), fiber supplements, stool-softeners as directed
– Diarrhea: loperamide as needed (provider guidance)

Notes: medicines work best alongside the lifestyle pillars above; side effects vary and should be reviewed with your clinician.

Follow-up and outlook

IBS is chronic but manageable. Most children improve with a combination of education, lifestyle changes, and targeted medicines.

• Keep a simple symptom/trigger diary to identify patterns
• Plan periodic follow-ups to reassess symptoms, review growth/weight, and adjust treatment
• If new red flags appear, your team may reassess and consider additional testing

Key points for families

• IBS is a disorder of gut–brain interaction—uncomfortable but not dangerous or damaging
• Workup rules out other diseases like celiac disease and IBD; endoscopy is not always needed
• No single cure, but many effective tools: balanced diet, good sleep, stress/mental health care, and targeted medications
• Partner with your care team to personalize the plan and keep life moving forward

References

 NASPGHAN. GI Kids: Patient Education Resources. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. https://www.gikids.org

 American Academy of Pediatrics (AAP). Pediatric Gastroenterology Clinical Reports and Patient Education. https://www.aap.org

 Blaufuss, T. Common Sense Pediatric GI: Practical Guidance for Families. Dakota Pediatric Gastroenterology, Fargo, ND, 2025.

 Hyams JS, Di Lorenzo C, Saps M, et al. Childhood Functional Gastrointestinal Disorders: Child/Adolescent. Gastroenterology. 2016;150(6):1456-1468.

 NASPGHAN. Irritable Bowel Syndrome in Children. GI Kids.

 AAP Clinical Report: Functional Abdominal Pain in Children and Adolescents. Pediatrics. 2021;147(2):e2020040281.