Welcome to this mini series all about IBS through our lifetimes. The next few episodes are going to focus on different stages of our lives from supporting your children with IBS, to when you’re teenagers and at university. Then through pregnancy and when you’ve just had a baby in the postpartum stage IBS during a menopause and then IBS in older people. Each episode will give you some strategies that focus on this particular challenges of this stage of life and give you some ideas of how to get better digestion. Today, I’m talking about children’s gut health and IBS in school, age, children.
This can be particularly challenging because you’re managing someone else’s digestion. We’re also going to cover early years, gut health and baby’s digestion. So let’s get started. And welcome to episode 85 of the inside knowledge podcast for people with IBS. I’m Anna Mapson And I’m really excited about this new series about managing a tricky digestion throughout your life cycle.
Do I work with IBS in children?
I don’t often work with children as my clients. I used to specialize in children’s nutrition. More generally. And I used to also run baby weaning classes a few years ago. But, it’s not something I do much at the moment. However I thought today, we could talk a bit about children’s gut health, like how your child’s microbiome is developed. And some of the challenges when you’re trying to support digestion for somebody else. These same kind of themes may come in when you are caring for a much older person at the end of their life as well. Who also has digestive issues because you’re kind of managing it on behalf of someone else.
Communicating with children about IBS
Now, obviously when you, we’ve got a very small child in nappies, you are seeing all of their poos and but when children get a bit older, like you obviously don’t see what goes into the toilet all the time. So you’re relying on communicating to them and depending on their age and the vocabulary and everything else.
It may or may not be easy to find that information out
Diagnosing IBS in kids
IBS in children is pretty much the same as IBS in anybody else. It’s just that we have got this added barrier of really trying to get to a good understanding of what it is they’re feeling without overwhelming them. then being able to communicate that to a doctor as well.
The diagnosis is very much the same as with adults in that you are looking for abdominal pain, that’s associated with having a bowel movement and maybe some changes in bowel movement. Moving towards constipation or more towards loose stools. Something, that’s not normal. That’s been going on for over three months and having some sort of episode, at least once a week. And that is the same kind of criteria, the Rome IV, that we use to diagnose any kind of IBS is the same for children.
What are the signs of IBS in children?
Some of the things you might look for are
- tummy aches, so frequent pain. Especially after eating, but not necessarily only just after a meal, it could also be later in the day could be by bedtime. If you think that’s the time through the day, when you’ve got the most amount of food in your stomach. Stomach aches are a big one.
- Changes in the poo. So if they’ve always been someone who had constipated or quite from stools, And suddenly they started getting a lot of diarrhea or the other way round that they used to. normal bowel movements. And then suddenly it’s very loose.
- You might notice them farting a lot, like very, very gassy or burping. or maybe even having a very distended stomach. So you might notice your child’s tummy really sticking out a lot. And that can be a sign that there’s a lot of gas in the hat and it can be quite uncomfortable and hard for them. Might find them having more accidents than normal, so not making it to the toilet. if they do. Have more frequent bowel movements and you’re not necessarily involved in them going to the toilet anymore.
- As they’re older. You might just find that they have a lot of skid marks in their pants. Like particularly if their bottom is a bit sore, they might have signs that. They haven’t been able to wipe it properly because it’s quite sore. Um, and then what, they might be able to tell you some of this stuff, but some of it might be embarrassing and they might not want to talk about it. And then around food, there might be some changes in the way that they eat.
- So potentially picking at their food a little bit, not really wanting big meals. off certain types of foods. they don’t like them. Now, this is tricky because this happens to children anyway, and this can be a normal part of development. So being picky with food isn’t necessarily something. That means that they’ve got IBS and tummy troubles. Could be their taste buds evolving.
Fussy eating in toddlers and digestive issues
We know that around age two to three children go through this neophobia phase where they don’t want anything new and scary. And it’s potentially one of our evolutionary mechanisms that’s been developed to stop toddlers wandering off and eating poisonous foods. But what in our world today where we don’t have very many poisonous foods around, they just tend to go into a bit of a beige phase and will only eat bread, cheese, pasta. In a very boring things. So that doesn’t necessarily mean they’ve got IBS. It just might be normal part of a toddler’s development.
Risk factors for developing gut issues in children
The risk factors are very similar, but there are some added things in children that may contribute to their IBS. So the risks for getting IBS might be.
Psychological stress – can be difficult to understand in very small children as well, especially in toddlers. May have excess worry, but they don’t have the language to be able to explain that to you. Maybe they’re more clingy. going and less risk-taking. So they’re wanting to stay home like less likely to go and play with new children. That could be signs of psychological distress, worry, anxiety. Whereas, of course, with older children and with adults, you can just ask them so we’ve got all of those kinds of the gut-brain connection, basically.
So things that are going on in our head that can still, children really be a part of it. The other added complication is sometimes because children don’t have the language to properly describe the physical sensations that they feel. They may say frequently, I’ve got a tummy ache to describe strong feelings that they have. feeling scared, Feeling angry, feeling lonely or whatever. A load of different. Emotions. These can sometimes be communicated to that caregiver as I’ve got a tummy ache. Tummy hurts.
And so it’s really hard to understand whether that is a physical pain or it’s a description of strong emotions.
Physical changes – Children, haven’t necessarily been able to communicate some of the pain or discomfort they feel as a baby. So very small children, could be having issues with their digestion right back to the time that they were born. It will also be structural problems, like strictures problems with the flow of food, through the intestines. That doesn’t get picked up right away and is only going back to the doctor for a repeated, checkups and, that you actually get, these things diagnosed.
It’s the same with problems like coeliac disease. It often takes years for that to be properly diagnosed in children.
Food allergies can also take a little while to get diagnosed, particularly where it’s a food that you don’t necessarily have that much exposure to. used to teach baby weaning classes a long time ago, and we’d always talk about the introduction of allergens. And there are a lot of allergens that are recognized and should be called out on the back of food packets. But some of them, you might not have much exposure to like celery, for example. Uh, even peanuts, if you don’t like peanuts, and then you come into contact with it, some of these things can be a little bit delayed in their It’s not always an immediate reaction. is noticeable. So it can be very hard in children to pick up on particular food allergies.
The first 1000 days – developing the gut microbiome
The things that really do affect your child’s gut microbiome development is this first thousand days.
That’s basically the first three years of their life. And it also can go right back to the mother’s pregnancy as well. as the micro-biome is passed from mother to child. So the same as your mitochondria, like that is one of the things that definitely only comes from the mother. But you’ve gut microbiome also does as well., we used to think that they had sterile gut in the womb. And now I think people are understanding more that we don’t have a sterile gut. Um, but we do certainly get seeded by the mother’s microbiome through the birth canal. So as the baby’s head is squeezed out, Often little bit of poo come out as well. And some of that may go near the babies eyes, mouth. Nose and that goes down into their stomach and helps to seed their gut microbes and it might sound a little bit gross. But essentially that’s how microbes are passed down from person to person. babies are born through C-section. And the baby is, you know, cut out. Then there’s none of that transfer of the good, healthy microbes from mother to child.
Sometimes people have thought about seeding the bacteria. So taking a swab of the vagina and pasting it onto the baby, just to try and transfer some of those microbes across. But. I think the science on that is not really clear. And it’s not always known whether they’re all healthy microbes that could be transferred.
So it’s not really a practice that. Should be encouraged, I think until we really know a lot more about it, however, the birth of your baby is one of the ways that you can influence their gut microbiome. So generally babies that are born through the vaginal canal tend to have a more healthy, more diverse gut bacteria than babies who are born by C-section. Another way that baby’s gut microbes are affected.
Or changed is through breastfeeding.
There is a great transfer of bacteria from the nipple and actually the milk to the babies digestion straight away. with the rise of more. C-section births and more. Formula fed babies. We have also seen a correlation in a rise in a topic conditions. So things like asthma, eczema and allergies. And it is thought that that’s something to do with the. Microbes in the gut, not being sufficiently diverse, not being challenged in the way that, you history, humans have been developed. Now, I don’t want anyone to feel guilty at all about having a C-section birth or having formula fed your baby. We have to do what we have to do.
And sometimes people make those choices for it’s just personal preference. Sometimes it’s like medical essential needs and I’m not sort of trying to disparage them. I’m just saying that that is potential for that to be a knock-on impact. In children’s gut health development. Now it doesn’t necessarily mean that if your baby has been born by C-section and formula fed that they are going to get asthma eczema or any allergies, it’s just that there’s an increased risk.
The other thing that affects your gut health development is the number of people living in the home. So typically firstborn children have a different sort of gut microbiome from. Second third, fourth other children, just because there’s more of a pool of people to mix wrong. And you know, small children are touching each other all the time.
The same with pets. If you have a pet in the house, you probably share a few microbes with your pets and children are going to pick up on this as well.
So, if you think that your child might be affected by IBS or some other digestive. discomfort. One of the first things I would do is try and take a pattern, like understand where you are now. What is the baseline? So, for example, if possible, trying to track down their bowel movements every day. So with smaller children, obviously you will know more about this. But they’re of school age, and they can describe this to you. It’s like really understanding how many bowel movements they’re having a day.
Then you could also try tracking their food. What are they actually eating? And just do a very simple first level analysis of this. Ideally, you don’t want to go launching into any restrictive diets like gluten free or cutting certain foods. Or even the FODMAP diet, which is a well-known tried and tested IBS diet.
We don’t want to be putting all those restrictions on to children unnecessarily. the first level of checks that I would do is. Making sure they’re drinking enough water. So this is particularly important if they are constipated to make sure that stools are not reabsorbing, lots of water, but it’s also equally important if they have got diarrhea and they might be losing a lot of liquid. So making sure they are well-hydrated and that can be really challenging when they’re at school, because they don’t always get a chance to keep a bottle near their desk and sip water throughout the day.
make sure they’ve had a drink in the morning, have a drink when they get home from school and where possible. I encourage them when they get an option at school to have a drink, to take that opportunity. So that’s one thing that you can make sure they’re drinking enough. Make sure they’re eating fruits and vegetables, because want to try and get a mix of fibres. This is the same for everybody with IBS, but particularly for children, we think about growing that micro-biome we want to try and get as much diversity in there as possible. not overdoing it, but we want to try and make sure that they’ve got a mix of fibres.
That’s the key. So some bulk forming fibre that will not be well digested, but forms a good stool by putting more content through the bowels. And then you also want gel forming fibres that are going to keep it soft, keep the water hydrated, because again, that makes it easier to pass. So there’s a real mix of. Bowel building fibres.
And then also just trying to support the gut. The microbes through giving them lots of diversity. Now, if your child’s already at that very fussy stage, this can be really challenging. If this is something new. You just think that they’ve started to get a bit of a dodgy tummy. this is something you can maintain is trying to go them interested in fruits and veggies.
Like you could look at different colors of the rainbow and can we eat something from every color on the rainbow every day? Something green something, orange, something red. Yellow, you know, Make it a little fun activity. to engage kids in the cooking as well.
Like, is there a way that they can help out with the food? See what goes into it so that they feel comfortable eating the food. you can also do things to try and accommodate certain. Taste preferences or whether we call it like children being fussy or whatever. I always think putting something safe on the plate every time you feed them.
So you know that they all going to eat something that they feel comfortable with. Every time, even if that means that they’re eating a lot of potatoes or. A lot of pasta, it’s just keeping the bowels moving because also what you don’t want is for them to get massively over, hungry, through not wanting to eat, because that can then lead to feeling more sick tummy aches.
And then when you do eat like eating quite quickly, which can overload the stomach. So children obviously might feel more wary of new foods. the other thing is to try and keep it fun, try and involve them, make it into a kind of family event to try some new foods. Keep up the variety.
If you have done these first-line checks, you’ve understood the basics of that diet and you still can’t really see any problems that might be contributing to their digestive distress. Then we might think about, is there something we can take out of the diets? So if they’re eating three meals a day, That eating some fruits and vegetables, they’re eating some carbohydrates and some protein. Then we can look to think, well, what might be causing these problems that they are eating that might need to come out. When we work with adults and we think about adults with IBS and typically the low FODMAP diet is recommended. There isn’t much evidence in children, however, evidence that that is shows it’s slightly positive to remove high FODMAP foods from your child’s diet. But we need to do this in a very careful way. So that they don’t become overly concerned. And also so that it’s not too overwhelming and you don’t want your child to go hungry.
So it’s much more tricky than it is with an adult. but typically foods plain whole foods. Tends to be the easiest way to manage this diet. So you can still have a baked potato, some rice, some protein like meat, fish, eggs, et cetera. And then some low FODMAP vegetables. At different meals.
This can be really challenging if they have their lunch at school. Because obviously you won’t be able to control that. So pack lunches might be easier in this instance, and then
if you haven’t yet been to the doctor about your child’s symptoms. I think it’s worth a check because there could be other things that need to be ruled out in order to diagnose IBS.
So, as we mentioned before, like it’s important to check for coeliac disease. Is that another kind of food allergy that hasn’t been discovered yet? Maybe they’ve got inflammatory bowel disease. So these things can easily be ruled out through your doctor. It’s much more challenging with a child because we don’t necessarily want to put some of these. Procedures that might happen more readily with adults.
Like an endoscopy. You get a camera down your throat. In a small child, like they could do that, but we don’t want to put our children through these things unnecessarily. That’s where it’s speaking to a really good doctor and potentially like getting referred to a pediatric specialist will be your best bet at uncovering. challenges. If if you’ve done these first line checks. So making sure that eating regularly, making sure that having some sort of variety of foods, then we can look at what might be taken out.
Typically people tend to think about removing gluten or dairy. Now dairy intolerance. Is relatively low. But can be anywhere up to about 20% of the whole population that is intolerant to dairy past about the age of five. So we all have an enzyme when we’re born that helps us digest milk. that’s lactase. Now in some of the world, people genetically do not have the ability to project process.
This. Lactose. past the age of about five. And people who do have that enzyme is called lactose persistent because actually a large proportion of the world do not have that. And so naturally it’s just a genetic change between different groups of people.
How to help your child with IBS
I’d like to finish this episode, just thinking about some specific concrete things that you can do. One of them would be to try and keep a record of the tummy aches, the pain, the diarrhoea, whatever it is, so that you can try and keep an objective view of things because. Often when I speak to parents they will say, oh, it’s happening all the time.
And then when we actually look at the evidence, it might just be once a week, but it feels more than that. Or there could be the other way round that you forget how many times it’s occurring. Because you just don’t notice. And there’s also things going on in your life, your work, your other children, perhaps. That crowd out some of the instances.
So trying to get very specific, write things down and that helps provide a base. That you can then look at that diet, and take it to the doctor to discuss issues with their digestion. Also try not to be embarrassed yourself about using language, about poo, farting gas, burping, that sort of thing.
Just try to make them feel comfortable about using whatever words you do as a family will allow them to talk freely about those things. Just trying to make it normal and not something to be embarrassed about because children can definitely pick up on that and it it can be easy for them to feel a bit more shame about having problems with their poo.
It might be worth talking to the school or nursery about as well. It’s just to really make sure that the person who’s caring for them at school. Really understands what their problems are and maybe any special help they need. Like, for example, if they need to go to the toilet, Please let them go. Because other children might be able to hold it in my child. Can’t like, it’s really worth making sure that it’s well communicated. And just being open with the nursery or the school so that can work together to try and resolve it.
Listen in for the other episodes coming up about older children, teenagers, and then going off to university. Which will come next week, but I’ll leave it there for this week.
Thanks very much for listening to this episode of the inside knowledge. Better digestion for everyone.
