India, Sept. 20 -- My 11-year-old daughter frequently complains of tummy pain, which sometimes keeps her awake at night. She has constipation on and off. All her tests have been normal. She is sensitive to things happening around her, and her pain and constipation seem to worsen during examinations. Could this be Irritable Bowel Syndrome? In many children recurrent abdominal pain is not caused by inflammation or infection or allergy. It may be due to Irritable Bowel Syndrome (IBS), a disorder of gut-brain interaction. According to the recently released Rome V criteria, IBS may be diagnosed when a child has abdominal pain on at least four days per month for at least two months. The pain is associated with passing stools, a change in stool frequency or a change in stool appearance, and cannot be fully explained by another medical condition. In children with constipation, abdominal pain remains the predominant concern even after the constipation has been appropriately treated [1]. Examinations, changing schools, friendship difficulties or problems at home may worsen symptoms in a susceptible child. The pain is real, but stress can turn up the volume of communication between the gut and brain. A recent systematic review involving more than 1.7 million children and adolescents from 34 countries estimated an overall IBS prevalence of 4.37% [2]. A recent global study found that 28% of children had at least one disorder of gut-brain interaction, while approximately 1.5% fulfilled the criteria for IBS [3]. Children with IBS may experience recurrent tummy pain, bloating, excessive gas, constipation, loose stools, urgency or a feeling of incomplete evacuation. However, IBS should not be assumed simply because initial tests are normal. Medical reassessment is needed if the child has blood in the stools, persistent severe diarrhoea, persistent fever or vomiting, unexplained weight loss, poor growth, marked abdominal distension, delayed puberty or a family history of inflammatory bowel disease. Once warning signs have been excluded, treatment begins with helping the child and family understand the condition. Regular meals, adequate sleep, physical activity, sufficient fluids and a consistent toilet routine are important. Soluble fibre may help, particularly when constipation is present, but it should be increased gradually. Unnecessary food restrictions should be avoided. Treatment should aim to restore normal activities rather than waiting for every episode of pain to disappear. Cognitive Behavioural Therapy helps children understand pain signals, reduce fear and develop healthier coping strategies. Children with constipation may require an osmotic laxative, while psyllium fibre may help reduce pain. Antibiotics and acid-suppressing medicines should not be routinely used for IBS. IBS does not usually affect growth or development. References 1. Di Lorenzo C et al. Lower and biliary disorders of gut-brain interaction: child and adolescent. Gastroenterology. 2026. 2. Jeong YD, et al. Global prevalence of functional abdominal pain disorders among children and adolescents according to the Rome III and IV criteria: a systematic review and meta-analysis. Gut Liver. 2025. 3. Nurko S, et al. Multinational prevalence and burden of paediatric disorders of gut-brain interaction: results of the Rome Foundation paediatric global study. Gut. 2026. Dr Anupam Sibal is a leading Paediatric Gastroenterologist and Hepatologist with over three decades of experience and five books to his credit, including the national bestseller, Is Your Child Ready to Face the World?...