Chronic abdominal pain in children: could it be IBS?

What is IBS in children?

What distinguishes abdominal pain caused by IBS from other types of stomach pain? First, its recurrence: more than 4 days a month, for more than two months. But that’s not all: the symptoms are linked to bowel movements and/or a change in stool frequency and/or appearance (Rome IV criteria ³). 

Is your teenager Raphaël often constipated, but you’re not sure if it’s IBS or functional constipation? It’s actually quite simple: if he has IBS, the pain will not go away when the constipation episode ends ².

What impact does IBS have on the child’s life and the family?

Although not life-threatening, IBS has a significant impact on children’s quality of life: missed school days, difficulty concentrating and remembering things, giving up sports, social isolation, low self-esteem, sleep disorders and fatigue, to name but a few.

The entire family unit is disrupted, whether emotionally (severe anxiety), economically (cost of treatment, sleep deprivation of parents and impact of medical appointments on their work) or in terms of daily life (giving up certain activities, time spent on diagnosis and treatment) ^2,4,5,6.

1 in 20 children are affected

Louise and Raphaël are far from being isolated cases. Globally, it is estimated that one in nine children suffer from a functional abdominal disorder, and that one in 20 children suffer specifically from IBS, the most common subtype of these disorders in children  ⁷.

Young Asians may be more affected than Europeans or Americans, but the difference remains slight and may be explained simply by different interpretations of diagnostic criteria  ⁷.

Risk factors

But above all, in the case of both Louise and Raphaël, IBS is more likely to be the result of a combination of factors, starting with psychological ones (anxiety about school or relationships, difficult experiences, etc.), which can make a child more susceptible to abdominal pain.

Has Louise suffered from gastrointestinal infections such as gastroenteritis, or food allergies? Does Raphaël enjoy foods that are too fatty, too spicy or too sweet? This could trigger or worsen their symptoms ².

The challenge of diagnosis in children

But here lies the first obstacle: symptoms vary from one child to another, to the extent that IBS has been classified into four subtypes.

Other difficulties might include young Louise struggling to describe her symptoms or teenager Raphaël feeling embarrassed to talk about them, while their parents may over- or under-interpret their child’s words depending on their stress or personal experience, increasing the risk of underdiagnosis.

Finally, there are undeniable cultural differences in the perception of pain and intestinal transit ^2,8.

Therefore, while IBS is the most common functional gastrointestinal disorder in children, its complex diagnosis often means a long, difficult and expensive experience for families.

Subtypes of irritable bowel syndrome (IBS) and their diagnostic criteria according to the Rome IV criteria:

IBS subcategories are very important in the management of affected children. ²

The origin is still very unclear

The mechanisms behind pediatric functional abdominal disorders in general, and IBS in particular, remain poorly understood in 2025. The prevailing theory suggests that IBS results from a disruption of the gut-brain axis ⁹.

Two mechanisms have been proposed ² :

• The top-down model suggests that the disorder begins in the brain: Louise’s symptoms may be triggered by her anxiety, as her brain sends abnormal signals to her gut causing pain, bowel problems and changes in the gut microbiota;
• The bottom-up model suggests that everything begins in the gut: Louise’s disorder may have been triggered by a gastrointestinal infection that sent pain alert messages to the brain.

(((INFOGRAPHIE : top-down / bottom-up models)))

While both mechanisms will likely coexist (bidirectional interaction between the brain and the gut) in Louise once the disorder is established, it remains difficult to know which one initiated it ².

The microbiota: just one piece of the puzzle

Whether it is the cause (bottom-up model) or the consequence (top-down model) of Louise’s IBS, the gut microbiota is now a major line of research. Several factors explain this interest:

• Louise’s gut microbiota influences her digestion, immunity and gut-brain communication;
• it is less diverse and some bacteria are more prevalent: this imbalance is called dysbiosis ^2,10,11; 
• a simple transfer of Louise’s microbiota to microbiota-free mice is enough to trigger symptoms in the rodents (visceral sensitivity, changes in bowel function, etc.) ².

Nevertheless, IBS remains a multifactorial condition: gut flora is just one piece of a much more complex puzzle.

Further studies are still needed, particularly in children, to confirm the role of the gut microbiota and, perhaps one day, to establish a profile of the gut bacteria associated with the disorder, or even to identify the “microbial signature” specific to each child in order to tailor treatment accordingly ². This is because the treatment Louise needs is not the same as that needed by Raphaël.

What this means for parents

The gut microbiota can therefore serve as a possible tool ¹² as part of a personalized, multidisciplinary therapeutic approach ^2,8.

A high-fiber diet and use of specific probiotics (to support beneficial bacteria) or antibiotics (to kill pathogenic bacteria) are strategies that could help Louise or Raphaël, always under medical supervision ^8,9.

From diagnosis to treatment decisions

Effective management of Louise’s IBS requires an accurate diagnosis: detailed medical history (background, medications, social and psychological factors) and a physical examination to rule out organic disorders ^2,8.

The IBS subtype (is Louise’s IBS constipation-predominant, diarrhea-predominant, mixed or unclassified?) must be identified as it will guide the therapeutic approach and the personalization of treatment over time ^2,8.

Once the diagnosis has been made, Louise and her family must work together with the medical team to make decisions: close communication between the child, family and medical staff improves treatment success.

Multidisciplinary management

Approaches combining multiple therapies, in addition to any medication strategies, deliver the best results ^{2, 5, 8, 13} :

• Psychology: communication and dialogue between child, parent and clinician ¹³
• Hypnotherapy (home-based or otherwise) ¹⁴, cognitive behavioral therapy (CBT), neurostimulation ¹³
• Nutrition: a personalized, child-centered approach incorporating advice from a dietitian, promoting fiber intake and avoiding age-inappropriate restrictive diets ¹³
• Probiotics, and more specifically lactobacilli such as Lactobacillus rhamnosus GG ^{5, 13} or L. reuteri ⁴, and prebiotics to selectively feed the good bacteria;
• Healthy lifestyle: physical exercise, sleep consistency.

Avoid:

• self-medication and/or dosages and durations exceeding local recommendations (e.g., repeated use of laxatives); 
• vicious cycles: parental anxiety, which increases as the child’s symptoms worsen, can undermine treatment. ²

(((EXTRAIT INFOGRAPHIE IBS KIDS : focus management des symptômes)))

IBS is diagnosed by a doctor or pediatrician. They can assess the situation, reassure your child and recommend appropriate treatment. If your child experiences frequent abdominal pain, talk to a healthcare professional. They can guide you to the most suitable solutions.

Warning signs requiring prompt medical attention

• Family history of chronic inflammatory bowel disease, celiac disease or peptic ulcer
• Persistent right-sided abdominal pain
• Difficulty swallowing or pain when swallowing
• Persistent vomiting
• Gastrointestinal bleeding
• Nighttime diarrhea
• Arthritis
• Sores or fissures around the anus
• Unintentional weight loss
• Slowed statural growth
• Delayed puberty
• Unexplained fever