Because most educational materials, research studies and other resources related to irritable bowel syndrome are focused on adults, readers may not be aware that children and adolescents can also develop IBS. A subset of these young people may have a parent or other genetic relatives who also have IBS or a commonly overlapping chronic condition, while others will have no known family history. According to IFFGD Fact Sheet #846,Irritable Bowel Syndrome (IBS) in Children, one source estimates that 14% of all high school students and 6% of middle school students show symptoms of IBS. (The overall prevalence of IBS in all ages is widely quoted as 10-20% depending on the source, and anywhere from 9-23% in different countries worldwide.) The international diagnostic criteria, Rome III, for pediatric IBS specifies ages 4-18. While in adults, IBS is statistically more common in women than men, IBS affects boys and girls equally.
Because of this relative dearth of youth-centered material, IBS Impact was pleased to learn recently of a relatively new book written especially for parents of children and teens with IBS or recurrent abdominal pain (RAP), also known as functional abdominal pain (FAP). RAP/FAP is a specific medical diagnosis that involves chronic abdominal pain similar to that in IBS but does not include disturbances in bowel movements. The book, The Gut Solution for Parents with Children Who Have Recurrent Abdominal Pain and Irritable Bowel Syndrome by Michael Lawson, M.D. and Jessica Del Pozo, PhD, (Lemke Health Partners:2013) appears to be a helpful resource for families.
Dr. Lawson is a board-certified gastroenterologist educated in both Australia and the United States who is currently practicing at Kaiser Permanente of Northern California, is a Clinical Professor at the University of California at Davis and has volunteered in Nicaragua, the Dominican Republic and Cambodia as part of his interest in multicultural medicine. Dr. Del Pozo is a licensed clinical psychologist, also at Kaiser Permanente of Northern California, who focuses on assisting those with chronic illnesses, including IBS and other chronic pain conditions. For several years, she and Dr. Lawson have collaborated as part of a multidisciplinary team treating school-aged children and teens with IBS or RAP/FAP. They use the SEEDS Program, which was developed by Dr. Lawson. SEEDS stands for Stress management, Education and communication, Exercise, Diet and Sleep, which the authors claim has been successful in reducing IBS or RAP/FAP symptoms long-term for the vast majority of several hundred youth who have participated since the program’s inception several years ago. This protocol has been presented at Digestive Disease Week, a large, well known annual international conference for professionals in the field of gastroenterology.
The Gut Solution is only 144-157 pages long, depending on edition, and although IBS and RAP/FAP are complex topics, is written in relatively easy to understand language and includes a glossary, all aspects that busy parents who are not health professionals themselves would probably appreciate. The authors begin with explanations of what IBS is and is not on the neurological, biological and physiological levels, with particular emphasis on the brain-gut interaction and visceral hypersensitivity that characterize functional gastrointestinal disorders like IBS and FAP, diagnosis, and how they differ from other common gastrointestinal diagnoses. The authors continue with a brief overview of most common conventional and complementary treatments, then systematically explain each aspect of the SEEDS protocol, including sample questions for family discussion, tips for both the youth and parents or guardians related to each element of the program. One child’s experiences are interspersed through much of the book as a case example. The stress management chapter includes some suggested techniques, the exercise chapter includes some sample exercises and the diet chapter includes an explanation of the low FODMAPs diet and other diet advice, some sample menu items, as well as a fluid replacement recipe suggested for chronic diarrhea. The authors emphasize the importance of creating and/or maintaining stable routines, open communication and clear, healthy boundaries and expectations as a means of reducing stress for the child or adolescent with IBS or RAP/FAP and other members of the household. They offer suggestions to parents for talking to and listening to their children about IBS or RAP/FAP at different developmental stages and note some possible pitfalls in communication in different parenting styles.
Overall, the information in The Gut Solution appears to be scientifically accurate, evidence-based and up-to-date as of its publication date of 2013. The advice is generally consistent with the multidisciplinary, biopsychosocial approach advocated by functional GI experts. It is a good balance between abstract scientific explanations and practical strategies for helping a child or adolescent with IBS or RAP/FAP reduce symptoms and manage the condition over the long term. The section on other syndromes connected to IBS and the chapter on sleep are particularly worthy of mention, as fatigue and/or sleep disturbances are common extraintestinal (non-GI) symptoms for many children and adults with IBS. Extraintestinal symptoms and commonly overlapping conditions are rarely discussed in detail in most written material for affected individuals, families or the general public.
For a relatively short book, The Gut Solution covers a great deal of varied information, but does have some curious omissions. For example, in the section on diagnosis, the Rome criteria are explained, but the actual term “Rome criteria” and the fact that they are international guidelines are never mentioned, meaning parents might not recognize the term if they encountered it elsewhere, or not realize that these are standard diagnostic criteria rather than the authors’ or individual physicians’ opinions. Although “mind-body medicines” are briefly alluded to in the subsection on treatments under complementary and alternative medicine, and a publication by Olafur Palsson, PsyD. and William Whitehead, MD of the University of North Carolina Center for Functional GI Disorders on psychological treatments for IBS is listed in a “further reading” section, the generally effective and well-established evidence-based psychological treatments of gut-directed hypnotherapy and cognitive behavioral therapy are absent from Dr. Lawson’s and Dr. DelPozo’s overview of current treatment options in the actual text. Regular readers of this blog may also notice that some of the authors’ statistics throughout their book differ a bit from those of the primary sources IBS Impact often quotes or links on this blog, but this is a minor concern.
It is likely that most parents who read The Gut Solution, whether their children have been recently diagnosed with irritable bowel syndrome or recurrent abdominal pain/functional abdominal pain or have dealt with symptoms for some time, will find the book useful to them to some extent, though not all aspects of the SEEDS protocol or the parenting advice will necessarily apply equally to all children or all family situations. IBS Impact encourages parents to use the portions that appear to be helpful to them and their child in conjunction with their child’s own health care providers. We also encourage families to continue learning from Dr. Lawson and Dr. Del Pozo’s “further reading” section and other reputable sources. IBS Impact’s main website has a specific page dedicated to children with IBS and another page for family and friends. In addition, most resources on the other pages of the main site, this blog and social media are applicable to both children and adults with IBS.
The Gut Solution: For Parents with Children Who Have Recurrent Abdominal Pain and Irritable Bowel Syndrome by Michael Lawson, MD and Jessica Del Pozo, PhD is available from major online booksellers in a paperback edition and in a Kindle e-book edition. Please note that the Kindle edition does not appear to include the book’s index. Also, search results bring up completely different books by different authors with similar main titles, such as Gut Solutions, so readers should be careful that they have located the correct book.
Dr. Lawson and Dr. Del Pozo’s website for the book is linked here.
Although IBS Impact received an early PDF version of the book for our reference, we receive no funding for this review or for any sales of the book. As with all of the information on this blog, our main website and social media, it is provided in the interest of scientifically accurate public awareness and assisting blog readers dealing with IBS to make informed choices for themselves or their families.