MDCalc

Rome IV Diagnostic Criteria for Child Irritable Bowel Syndrome (IBS)

Official Rome IV criteria for the diagnosis of child irritable bowel syndrome (IBS).

Use in a child or adolescent with symptoms suggestive of irritable bowel syndrome (IBS), such as chronic and recurrent abdominal pain related to defecation and/or changes in stool frequency or form for at least 2 months.   

Patients with any of the following alarm features must be evaluated clinically for other diagnoses even though IBS may be present:

  • Family history of inflammatory bowel disease, celiac disease, or peptic ulcer disease.

  • Persistent right upper or right lower quadrant pain.

  • Dysphagia.

  • Odynophagia.

  • Persistent vomiting.

  • Gastrointestinal blood loss.

  • Nocturnal diarrhea.

  • Arthritis.

  • Perirectal disease.

  • Involuntary weight loss.

  • Deceleration of linear growth.

  • Delayed puberty.

  • Unexplained fever.

Must have the following:

For ≥2 months prior

1. Related to defecation
2. A change in frequency of stool
3. A change in form (appearance) of stool

Diagnostic Result

Please fill out required fields.
Advice

If diagnosis not met (negative):

Current symptoms are unlikely to be caused by IBS. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above. 

If meets diagnosis (positive):

Likely diagnosis of IBS. Consider initiating treatment.

Management

Management of irritable bowel syndrome (IBS) is based on the most bothersome symptoms, predominant bowel habit pattern, and severity of symptoms. Treatments include:

  • Education about the diagnosis and the current understanding of disorders of the gut-brain interaction including IBS.

  • Providing reassurance.

  • Probiotics.

  • Dietary changes (e.g. low FODMAP diet, soluble fiber).

  • Peppermint oil.

  • Anti-spasmodics (e.g. hyoscyamine, dicyclomine).

  • Neuromodulators (e.g. tricyclic antidepressants, serotonin reuptake inhibitors, gabapentin, pregabalin).

  • Psychological therapies to address anxiety and/or psychological stressors(e.g. cognitive behavioral therapy, hypnotherapy, learning of coping strategies).

  • Acupuncture, complementary alternative medications.

  • Neurostimulator (e.g. IB-Stim).

  • For IBS-C: Laxatives (e.g. polyethylene glycol (PEG), lactulose, magnesium hydroxide, senna, bisacodyl, linaclotide, lubiprostone, plecanatide) and prokinetics (e.g. prucalopride or tegaserod).

  • For IBS-D: Antidiarrheals (e.g. loperamide, eluxadoline), antibiotics (e.g. rifaximin), bile acid binders (e.g. cholestyramine, colestipol, colesevelam), ondansetron.

  • A multidisciplinary treatment approach should be considered, especially in severe cases. 

  • Severely disabled patients may require more intensive rehabilitation in the form of a day or inpatient program.  

The choice of therapy is outside the scope of this calculator and will depend on clinical context.

Some of the pharmacologic interventions have not been studied in children and/or adolescents and can only be used off-label.

No pediatric clinical guidelines for evaluation or treatment of child IBS are available, however there are clinical guidelines for adults that may be useful.

Critical Actions

This calculator should only be used in pediatric patients who do not have signs or symptoms suggestive of a structural/mechanical, metabolic or systemic cause of their symptoms based on clinical history, physical exam and initial work-up.

Have feedback about this calculator?