{"id":4060,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/irritablebowelsyndromeibsfunctionalabdominalpainfap\/"},"modified":"2023-09-14T15:26:10","modified_gmt":"2023-09-14T14:26:10","slug":"irritablebowelsyndromeibsfunctionalabdominalpainfap","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatricgastrointestinal\/irritablebowelsyndromeibsfunctionalabdominalpainfap\/","title":{"rendered":"Irritable Bowel Syndrome (IBS) and Functional Abdominal Pain (FAP)"},"content":{"rendered":"\n<p><strong>Information <\/strong><\/p>\n\n\n\n<p>IBS\/FAP is common.&nbsp; 10-15% of school aged children will experience abdominal pain but 90% of these children will have no organic pathology identified.&nbsp; FAP is usually multifactorial; anxiety and parental attention to symptoms usually make things worse whereas acceptance and support usually promote improvement.&nbsp; The teams at SJH &amp; RHSC\/RHCYP have come together to create this helpful guide to be used by anyone supporting families with possible&nbsp;FAP &#8211; 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: <a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/PAEDIATRIC-IRRITABLE-BOWEL-SYNDROME-AND-FUNCTIONAL-ABDOMINAL-PAIN-v-7-1.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/PAEDIATRIC-IRRITABLE-BOWEL-SYNDROME-AND-FUNCTIONAL-ABDOMINAL-PAIN-v-7-1.pdf\" target=\"_blank\">Paediatric IBS and Abdominal Pain<\/a><\/p>\n\n\n\n<p>Typically, children and young people with functional bowel conditions will show many of the features:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&gt;3 episodes per month for at least 2m<\/li>\n\n\n\n<li>in IBS, pain is often related to opening bowels and also often a change is bowel habit<\/li>\n\n\n\n<li>&gt;3 yr old<\/li>\n\n\n\n<li>daily activities are affected<\/li>\n\n\n\n<li>usually primary care tests are all negative<\/li>\n\n\n\n<li>may be associated with other symptoms &#8211; headache, sleep disturbance<\/li>\n<\/ul>\n\n\n\n<p>Assessment:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>ask about location of pain, bowel habit, exacerbating and relieving factors and check if the child is well between episodes<\/li>\n\n\n\n<li>dietary triggers: irregular eating patterns, overeating, diets high in fat, sugar, caffeine, carbonated drinks<\/li>\n\n\n\n<li>physical triggers: recent viral illness, food intolerances, chronic illness, low activity levels<\/li>\n\n\n\n<li>psychosocial triggers: problems at school, problems at home, significant life events, use of social media, school avoidance<\/li>\n\n\n\n<li>FHx&nbsp;triggers: parents\/carers or siblings with IBS, GORD, constipation, mental health problems<\/li>\n\n\n\n<li>remember to unlock parental ICE: ideas, <em><strong>concerns<\/strong><\/em> and expectations<br><\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>for health visitors\/school nurses, refer to GP\/primary care team<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>for GP\/primary care team, refer any patient that has red flags (involuntary weight loss, dysphagia, persistent vomiting, faltering growth, etc.)<\/li>\n\n\n\n<li>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<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><em>&nbsp;<\/em><\/strong>where no red flags exist and there is a good relationship between family and healthcare provider, primary care assessment and investigation may well suffice<\/li>\n\n\n\n<li>after careful history taking and examination, consider blood tests (Coeliac screen, FBC, UE, CRP, LFT, ESR), urinalysis, FCP if &gt;5yr, Stool for helicobacter, pregnancy test and PUSS where appropriate<\/li>\n\n\n\n<li>where all tests are normal, consider using (Link to PILs)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Where to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>for Edinburgh patients, refer General Medicine RHCYP<\/li>\n\n\n\n<li>for West Lothian patients, refer Paediatrics SJH<\/li>\n\n\n\n<li>for patients in Fife and Borders, please refer to local services&nbsp;<em>first<\/em>&nbsp;and they can refer on to RHCYP where needed.<\/li>\n\n\n\n<li>refer using SCI-GW &#8211; remember to use &#8216;Advice only&#8217; if this is more appropriate.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>\u200b<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"\/files\/sites\/2\/G.I-Abdominal-Pain-flowchart-paeds.png\" alt=\"G.I. Abdominal Pain flowchart paeds\"><\/figure>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"\/files\/sites\/2\/IBS-FAP-PILs-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">IBS-FAP-PILs 1.pdf<\/a><\/p>\n\n\n\n<p><a href=\"\/files\/sites\/2\/IBS-FAP-PILs-2.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">IBS-FAP -PILs 2.pdf<\/a><\/p>\n\n\n\n<p><a href=\"\/files\/sites\/2\/IBS-FAP-PILs-3.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">IBS-FAP-PILs 3.pdf<\/a><\/p>\n\n\n\n<p><a href=\"\/files\/sites\/2\/IBS-FAP-PILs-Sore-Tummies.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">IBS-FAP-PILs Sore Tummies.pdf<\/a>\u200b<\/p>\n\n\n\n<p><a href=\"\/files\/sites\/2\/IBS-FAP-Symptom-Diary.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">IBS-FAP-Symptom Diary.pdf<\/a><\/p>\n\n\n\n<p><strong>CAMHS link to general online resources:<\/strong>&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/camhs\/resources\/\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/camhs\/resources\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/camhs\/Resources\/Online\/Pages\/default.aspx<\/a>&nbsp;<\/p>\n\n\n\n<p><strong>IBS Food fact sheet:<\/strong>&nbsp;<a href=\"https:\/\/www.bda.uk.com\/uploads\/assets\/5eded447-080a-4113-9b3cfc70e432fbd5\/IBS-food-fact-sheet.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.bda.uk.com\/uploads\/assets\/5eded447-080a-4113-9b3cfc70e432fbd5\/IBS-food-fact-sheet.pdf<\/a><\/p>\n\n\n\n<p><strong>Link to Ref Help&nbsp;Faecal&nbsp;calprotectin:<\/strong>&nbsp;<a href=\"\/files\/sites\/2\/calprotectin-in-children-NHSL-Sept-2018.pdf\" data-type=\"URL\" data-id=\"\/files\/sites\/2\/calprotectin-in-children-NHSL-Sept-2018.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/ResourcesLinks\/calprotectin in children NHSL Sept 202018.pdf<\/a><\/p>\n\n\n\n<p><strong>Link to RefHelp H Pylori:<\/strong><\/p>\n\n\n\n<p><a href=\"\/files\/sites\/2\/Paed-GI-Heliobacter-Pylori-RHCYP-22-Aug-2019.pdf\" data-type=\"URL\" data-id=\"\/files\/sites\/2\/Paed-GI-Heliobacter-Pylori-RHCYP-22-Aug-2019.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/ResourcesLinks\/Paed GI Heliobacter Pylori RHCYP Aug 2019.pdf<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Helpful Apps:<\/h4>\n\n\n\n<p><strong>Mindshift&nbsp;<\/strong>(free CBT) :&nbsp;<a href=\"https:\/\/play.google.com\/store\/apps\/details?id=com.bstro.MindShift&amp;hl=en_GB\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/play.google.com\/store\/apps\/details?id=com.bstro.MindShift&amp;hl=en_GB<\/a><\/p>\n\n\n\n<p><strong>HospiChill<\/strong>&nbsp;(Preparation for coming to hospital and appointments but also great activities to reduce stress, manage anxiety, pain) &nbsp;<a href=\"http:\/\/hospichill.net\/index.html\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/hospichill.net\/index.html<\/a><\/p>\n\n\n\n<p><strong>Relax Lite\u00a0<\/strong>(relaxation):\u00a0https:\/\/play.google.com\/store\/apps\/details?id=com.saagara.relaxlite.app&amp;hl=en_GB&amp;gl=US<\/p>\n\n\n\n<p><strong>Smiling Mind<\/strong>&nbsp;(relaxation)&nbsp;<a href=\"https:\/\/play.google.com\/store\/apps\/details?id=com.smilingmind.app&amp;hl=en_GB&amp;gl=US\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/play.google.com\/store\/apps\/details?id=com.smilingmind.app&amp;hl=en_GB&amp;gl=US<\/a><\/p>\n\n\n\n<p><strong>Chill Panda&nbsp;<\/strong>(for children and adults who want to learn how to mange stress and worry and feel better)&nbsp;<a href=\"https:\/\/www.nhs.uk\/apps-library\/chill-panda\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhs.uk\/apps-library\/chill-panda<\/a><\/p>\n\n\n\n<p><strong>Stress control classes<\/strong>&nbsp;(free online):&nbsp;&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/stresscontrol\/\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/stresscontrol\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/stresscontrol\/Pages\/default.aspx<\/a>&nbsp;(adult classed but suitable for mid-teens upwards)<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information IBS\/FAP is common.&nbsp; 10-15% of school aged children will experience abdominal pain but 90% of these children will have no organic pathology identified.&nbsp; FAP is usually multifactorial; anxiety and parental attention to symptoms usually make things worse whereas acceptance and support usually promote improvement.&nbsp; The teams at SJH &amp; RHSC\/RHCYP have come together to<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3956,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[521],"class_list":["post-4060","page","type-page","status-publish","hentry","category-irritable-bowel-syndrome-ibs-functional-abdominal-pain-fap"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/paediatric\/paediatric-gastrointestinal\/irritable-bowel-syndrome-ibs-functional-abdominal-pain-fap\/\" rel=\"tag\">Irritable Bowel Syndrome (IBS)Functional Abdominal Pain (FAP)<\/a>","rttpg_excerpt":"Information IBS\/FAP is common.&nbsp; 10-15% of school aged children will experience abdominal pain but 90% of these children will have no organic pathology identified.&nbsp; FAP is usually multifactorial; anxiety and parental attention to symptoms usually make things worse whereas acceptance and support usually promote improvement.&nbsp; The teams at SJH &amp; RHSC\/RHCYP have come together to","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4060","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4060"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4060\/revisions"}],"predecessor-version":[{"id":13923,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4060\/revisions\/13923"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3956"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4060"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4060"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}