The low FODMAP diet in children – are we there yet?

A recent publication by our group explored the application of the low FODMAP diet in the paediatric setting. Here’s our summary.

What did we find?

Although there is good evidence in adults that this diet works effectively to treat IBS, the research base in children is still growing. Despite lots of clinicians prescribing the diet to children globally, the studies so far are limited and mixed, which makes it difficult to interpret how the diet will work in a real-world setting. For example, one study lasted for only 48 hours, and other studies used small numbers of participants that were aged between 5 and 17. The needs of a 5-year-old versus the needs of a 17-year-old are vastly different and really need to be considered when putting any kind of restrictive diet into practice. Some of the studies did see promising results in reducing gastrointestinal symptoms, but there are other factors that we must consider before restricting FODMAP intake in children.

What else do we need to consider when approaching the conversation of FODMAPs in children?

Nutrition and growth:

There is no doubt that nutrition is essential for adequate growth and development in childhood and adolescence. By restricting intake of foods and food groups, there is potential risk of nutritional inadequacies. Interestingly, when looking at the research, many children unfortunately already do not eat the recommended servings of fruits, vegetables, grains or dairy. One study found that with the support of a dietitian to instruct on the low FODMAP diet, children’s intake of foods from core food groups actually increased, while more discretionary foods decreased. However, not everyone has access to specialist dietitians, and more longer-term research is needed to see how the diet impacts on growth and development during different developmental stages.

Disordered eating:

All of the research currently looking into eating disorders/disordered eating patterns and IBS specifically are in an adult population. There are warranted concerns that prescribing this diet will exacerbate eating disorders in a very vulnerable group, particularly adolescence, where body image concerns are heightened. This is an extremely complex area, where limiting diet is inappropriate, and other treatment options, such as fibre supplements, medications, psychological therapies and herbal remedies play a role.

Impact on the family:

We know how busy family life can be, and changing one person’s diet often means the whole family unit is impacted. Depending on where we get information from, it can be confusing and challenging for families. The support of a dietitian provides access to tailored advice to minimise this impact. Other resources such as apps, food lists, recipes, food certification programs that allow for visual identification of low FODMAP products, all go a long way in supporting families.

How can the low FODMAP diet be safely used in children?

If a young person has gastrointestinal issues, we firstly recommend seeing a doctor to get a diagnosis of IBS. The dietitian will then determine if and how to manipulate food intake to reduce symptoms. While we wait for more research, a practical approach is known as ‘FODMAP gentle'. This is a less restrictive form of the diet, where only some of the key high FODMAP foods are reduced, keeping other high FODMAP foods as part of the diet. More information about this can be found here.