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Irritable Bowel Syndrome (IBS) and Functional Abdominal Pain (FAP)

Information

IBS/FAP is common.  10-15% of school aged children will experience abdominal pain but 90% of these children will have no organic pathology identified.  FAP is usually multifactorial; anxiety and parental attention to symptoms usually make things worse whereas acceptance and support usually promote improvement.  The teams at SJH & RHSC/RHCYP have come together to create this helpful guide to be used by anyone supporting families with possible FAP – including health visitors, school nurses, primary care teams (nursing and medical) as well as other people engaged in the care of younger people, more detailed information can be found here: Paediatric IBS and Abdominal Pain

Typically, children and young people with functional bowel conditions will show many of the features:

  • >3 episodes per month for at least 2m
  • in IBS, pain is often related to opening bowels and also often a change is bowel habit
  • >3 yr old
  • daily activities are affected
  • usually primary care tests are all negative
  • may be associated with other symptoms – headache, sleep disturbance

Assessment:

  • ask about location of pain, bowel habit, exacerbating and relieving factors and check if the child is well between episodes
  • dietary triggers: irregular eating patterns, overeating, diets high in fat, sugar, caffeine, carbonated drinks
  • physical triggers: recent viral illness, food intolerances, chronic illness, low activity levels
  • psychosocial triggers: problems at school, problems at home, significant life events, use of social media, school avoidance
  • FHx triggers: parents/carers or siblings with IBS, GORD, constipation, mental health problems
  • remember to unlock parental ICE: ideas, concerns and expectations

Who to refer:

  • for health visitors/school nurses, refer to GP/primary care team
  • for GP/primary care team, refer any patient that has red flags (involuntary weight loss, dysphagia, persistent vomiting, faltering growth, etc.)
  • refer any patient where there is a strong suggestion of organic disease, repeated attendances at practice or ED, breakdown in relationship with 1y care (loss of confidence), significant history of atopy

Who not to refer:

  •  where no red flags exist and there is a good relationship between family and healthcare provider, primary care assessment and investigation may well suffice
  • after careful history taking and examination, consider blood tests (Coeliac screen, FBC, UE, CRP, LFT, ESR), urinalysis, FCP if >5yr, Stool for helicobacter, pregnancy test and PUSS where appropriate
  • where all tests are normal, consider using (Link to PILs)

Where to refer:

  • for Edinburgh patients, refer General Medicine RHCYP
  • for West Lothian patients, refer Paediatrics SJH
  • for patients in Fife and Borders, please refer to local services first and they can refer on to RHCYP where needed.
  • refer using SCI-GW – remember to use ‘Advice only’ if this is more appropriate.

G.I. Abdominal Pain flowchart paeds

IBS-FAP-PILs 1.pdf

IBS-FAP -PILs 2.pdf

IBS-FAP-PILs 3.pdf

IBS-FAP-PILs Sore Tummies.pdf

IBS-FAP-Symptom Diary.pdf

CAMHS link to general online resources: https://services.nhslothian.scot/camhs/Resources/Online/Pages/default.aspx 

IBS Food fact sheet: https://www.bda.uk.com/uploads/assets/5eded447-080a-4113-9b3cfc70e432fbd5/IBS-food-fact-sheet.pdf

Link to Ref Help Faecal calprotectin: https://apps.nhslothian.scot/refhelp/guidelines/ResourcesLinks/calprotectin in children NHSL Sept 202018.pdf

Link to RefHelp H Pylori:

https://apps.nhslothian.scot/refhelp/guidelines/ResourcesLinks/Paed GI Heliobacter Pylori RHCYP Aug 2019.pdf

Helpful Apps:

Mindshift (free CBT) : https://play.google.com/store/apps/details?id=com.bstro.MindShift&hl=en_GB

HospiChill (Preparation for coming to hospital and appointments but also great activities to reduce stress, manage anxiety, pain)  http://hospichill.net/index.html

Relax Lite (relaxation): https://play.google.com/store/apps/details?id=com.saagara.relaxlite.app&hl=en_GB&gl=US

Smiling Mind (relaxation) https://play.google.com/store/apps/details?id=com.smilingmind.app&hl=en_GB&gl=US

Chill Panda (for children and adults who want to learn how to mange stress and worry and feel better) https://www.nhs.uk/apps-library/chill-panda

Stress control classes (free online):  https://services.nhslothian.scot/stresscontrol/Pages/default.aspx (adult classed but suitable for mid-teens upwards)