Functional Gastrointestinal Disorders in Children: Is food a friend or foe?

Functional gastrointestinal disorders (FGIDs) are prevalent, affecting approximately 10-25% of school-aged children.1-3 Twenty-five to 75% of adults with Irritable Bowel Syndrome (“IBS”) report specific food-induced worsening of their gastrointestinal (GI) symptoms such as abdominal pain and diarrhea.4 Adults with IBS identify diets high in carbohydrates, fatty foods, coffee, alcohol, and hot spices as the primary culprits.5 The perceived role of specific foods on GI symptoms in children with FGIDs is unknown.

A recent study conducted at Children’s Nutrition Research Center in coordination with Baylor College of Medicine, Texas Children’s Hospital, and Texas Woman’s University in Houston, Texas, studied children with FGIDs and perceived food intolerances.6 Twenty-five children completed multiple questionnaires (verified by parental input), as well as a focus group to further discuss coping mechanisms and impact of food intolerances on quality of life.

Children identified the following foods as leading to most GI symptoms:

  • spicy food (68%)
  • pizza (52%)
  • cow’s milk (56%)
  • fried foods (48%)
  • deep-fried foods (44%)
  • fast foods (40%)
  • sodas (40%)
  • cheese (40%)
  • ice cream (36%)
  • salsa (35%)

Based on review of a 24-hour diet recall, 64% of children had eaten an identified perceived symptom-inducing food within 24 hours of the study visit.  During the focus groups, children identified multiple coping strategies for food induced symptoms. These included complete avoidance or decreased consumption of the food. Seventy-two percent of participants believed that avoidance of all foods that induced symptoms would lead to cessation of all their GI symptoms.

Children also modified (e.g., attempting to wipe away excess pasta sauce from pizza) or sought out foods in different states (e.g., ripened vs. un-ripened bananas) given the perception that foods of one state may influence GI symptom onset (see Table). Children also identified that food consumption could help their symptoms. These included chewing gum, consuming mints, and drinking water. Additional foods identified by participants that could help GI symptoms included: popsicles, bread, yogurt, saltine crackers, and various fruits. The majority of the work with respect to food and GI symptoms in FGIDs is related to exacerbation of symptoms and not their amelioration.6

Comparison of Foods Identified as Causing More or Less Pain Based upon Food State during Focus Group Sessions.

Identified as Causing Less Pain

Identified as Causing More Pain

Unripened Banana

Ripened Banana

Higher Fat Milk (2% / Whole)

Low Fat Milk (1% / Skim)

White Meat Chicken

Dark Meat Chicken

Small Oranges

Large Oranges

Clear Sodas

Dark Sodas

Dark Chocolate

Milk Chocolate

Goat or American Cheese

Other Cheeses

 References:

  1. Apley J. The Child with Abdominal Pains. Oxford: Blackwell Scientific Productions, 1975.
  2. Hyams JS, Treem WR, Justinich CJ, et al. Characterization of symptoms in children with recurrent abdominal pain: resemblance to irritable bowel syndrome. J.Pediatr.Gastroenterol.Nutr. 1995;20:209-214.
  3. McOmber ME, Shulman RJ. Recurrent abdominal pain and irritable bowel syndrome in children. Curr Opin Pediatr 2007;19:581-5.
  4. Monsbakken KW, Vandvik PO, Farup PG. Perceived food intolerance in subjects with irritable bowel syndrome– etiology, prevalence and consequences. Eur J Clin Nutr 2006;60:667-72.
  5. Simren M, Mansson A, Langkilde AM, et al. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion 2001;63:108-15.
  6. Perceived Food-Induced Gastrointestinal Symptoms and Their Impact on Quality of Life in Children with Functional Gastrointestinal Disorders. Unpublished Manuscript.
  7. Huertas-Ceballos AA, Logan S, Bennett C, et al. Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Re 2009:CD003019.

By Shelley Carlson, MS, RD, LD

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