Diet Changes for Functional Abdominal Pain in Children

Published on Thursday, March 16, 2023 by Haley McGaha

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Functional abdominal pain is a common disorder in children.

Functional abdominal pain (FAP)/irritable bowel syndrome (IBS) in children/adolescents is associated with school absences, reduced quality of life, and increased psychological distress. These diagnoses can be so frustrating because treatment options are scarce since the cause of abdominal pain is not well understood.

Because treatment is so scarce, many choose to look at diet changes in hopes of relief from symptoms. 

Over 90% of adolescents with IBS report that eating induces their symptoms, therefore, leading to diet changes, and for some, skipping meals. 

A review completed by A.L. van Tilburg et al. examined if certain foods could make symptoms worse, if some foods could improve symptoms, and what role foods play in ongoing symptoms.

 

Let’s look at their findings to see if changing eating patterns can help with FAP/IBS.

 

Milk -

A population study done in Finland found that out of mothers with children 0-11 years old who suspected milk intolerance, and therefore, avoided dairy products, 14% of those actually had an allergy or intolerance. Thus, a majority of those who avoided dairy products really did not need to. Several other studies found that eliminating dairy did not alleviate FAP. This leads some to assume that lactose intolerance is not a true culprit for patients with FAP/IBS.

 

Gluten -

One study out of the Journal of Pediatric Gastroenterology and Nutrition found that only 1 of 227 patients (5-18 years old) with recurrent abdominal pain had celiac disease (CD) upon testing. Other studies have found that those children with known CD still have abdominal pain, even after being gluten-free for 1 year. Other studies have found that some people may test positive for CD on lab work, but upon biopsy, do not have CD. Further exploration is needed before gluten avoidance can be recommended for children FAP/IBS.

 

FODMAPs -

In adults, it has been reported that as many as 74% of people who followed a Low FODMAP diet reported improvement. In children, much less evidence is available for the effect of FODMAPs on IBS. Some studies show that the most helpful avoidance was fructose. One study reported that the majority (81%) of children who avoided fructose, reported improvements in their symptoms within 2 weeks.

 

So, which foods or supplements may be beneficial for FAP?

 

Fiber –

The consumption of fiber below the daily recommended amount is a risk factor for FAP. Here are recommendations for adequate consumption of fiber:

•         Adults and children >4 years old: 28 grams/day
•         Children 1-3 years old: 14 grams/day

Peppermint oil –

Peppermint oil is known for its antispasmodic properties by relaxing GI smooth muscle. It has been widely used for IBS, however, little data is available on the efficacy of its use in children. Therefore, precautions should be used. Overuse has been associated with intestinal nephritis and acute renal failure and it may even exacerbate GERD.

In infants and young children, it may cause apnea. Luckily, peppermint products sold in over-the-counter capsules, teas, and topical rubs are considered fairly well tolerated due to their low dosage and can be a cheaper treatment option for FAP.

 

Probiotics –

There is good evidence for the use of probiotics in FAP and in helping to reduce symptoms, however, more studies are needed to determine which strain is the most effective.

 

In conclusion, a lot of research has shown that there is little proof that diet plays a role in childhood FAP/IBS, which may not be a bad thing since research shows a slight risk of developing eating disorders due to dietary changes for FAP. Although it may be frustrating to know that diet changes may not help relieve symptoms, a positive way to look at this is that more research is coming out on foods that may help relieve symptoms.

1. _{van Tilburg, M. A. L., & Felix, C. T. (n.d.). Diet and functional abdominal pain in children and adolescents. Journal of pediatric gastroenterology and nutrition. Retrieved February 11, 2023, from https://pubmed.ncbi.nlm.nih.gov/23698023/}  
2. _{Kokkonen, J., Haapalahti, M., Tikkanen, S., Karttunen, R., & Savilahti, E. (2004). Gastrointestinal complaints and diagnosis in children: a population-based study. Acta paediatrica (Oslo, Norway : 1992), 93(7), 880–886. https://pubmed.ncbi.nlm.nih.gov/15303801/} 
3. _{Hyams, J. S., Treem, W. R., Justinich, C. J., Davis, P., Shoup, M., & Burke, G. (1995). Characterization of symptoms in children with recurrent abdominal pain: resemblance to irritable bowel syndrome. Journal of pediatric gastroenterology and nutrition, 20(2), 209–214. https://doi.org/10.1097/00005176-199502000-00012} 
4. _{Shepherd, S. J., & Gibson, P. R. (2006). Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. Journal of the American Dietetic Association, 106(10), 1631–1639. https://doi.org/10.1016/j.jada.2006.07.010} 
5. _{Gomara, R. E., Halata, M. S., Newman, L. J., Bostwick, H. E., Berezin, S. H., Cukaj, L., See, M. C., & Medow, M. S. (2008). Fructose intolerance in children presenting with abdominal pain. Journal of pediatric gastroenterology and nutrition, 47(3), 303–308. https://doi.org/10.1097/MPG.0b013e318166cbe4} 
6. _{Chumpitazi BP, Weidler EM, Shulman R. (2011) A multi-substrate carbohydrate elimination diet decreases gastrointestinal symptoms in a subpopulation of children with IBS. Gastroenterology, 140, 10.1016/S0016-5085(11)63105-3.} 
7. _{U.S. Department of Health and Human Services. (n.d.). Office of dietary supplements - daily values (DVS). NIH Office of Dietary Supplements. Retrieved February 11, 2023, from https://ods.od.nih.gov/HealthInformation/dailyvalues.aspx/}  

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