FODMAPs and your Child
An apple a day may not keep the doctor away…
Over the past 6 years, there has been exciting research undertaken at Monash University looking at possible dietary triggers for Irritable Bowel Syndrome (IBS). The result of this research is the discovery of a group of dietary sugars which, when ingested by susceptible individuals, causes a range of gastrointestinal symptoms associated with IBS. This group of sugars is called FODMAPs (Fermentable Oligo-saccharides, Di- saccharides, Mono-saccharides and Polyols) and it has changed the face of IBS management around the world.
When you think of IBS, you will often think about adults, but more and more children are now presenting with a history of months and sometimes years of gastrointestinal complaints such as:
- Tummy pain,
- Bloating or visible abdominal distension,
- Excessive wind,
- Diarrhoea +/- associated nappy rash and/or
- Constipation +/- soiling.
The symptoms of IBS are similar to those of other conditions, such as Coeliac Disease, Inflammatory Bowel Diseases (Crohn’s Disease and Ulcerative Colitis) and Bowel Cancer, and as such, it is crucial that these conditions are investigated prior to making any changes to a child’s diet.
The diagnostic test for FODMAP malabsorption is a breath test. The test involves the ingestion of a specific dose of the FODMAP being tested (currently only able to test for Fructose, Lactose and Sorbitol) followed by half hourly breathing into a special bag (for up to three hours) to check the levels of hydrogen or methane produced in the breath. The presence of either of these two gases is indicative of malabsorption of that FODMAP by the gut.
In a nutshell, someone with FODMAP malabsorption is unable to adequately absorb one or more FODMAPs in their small intestine, leaving too much of those FODMAPs to travel further along the digestive system where they are then fermented or broken down by bacteria present in the large intestine, which can results in a range of gut symptoms (as listed earlier).
In young children, the breath test is not always possible due to their inability to blow into the bag adequately to get an accurate reading. As such, in the absence of these results, a process of elimination and challenge under the guidance of an experienced dietitian is required.
When seeing a dietitian for guidance regarding a low FODMAP diet for your child, a comprehensive diet and symptom history will usually be taken to determine the most likely FODMAPs that may be causing your child’s symptoms and guidance regarding the avoidance of those FODMAPS for a STRICT 4 week period will be provided.
Following this 4 week period, and assuming a complete resolution of your child’s symptoms has been achieved, a challenge process will be recommended to pinpoint the exact dietary triggers for your child and to determine their threshold for the problematic FODMAPs. In most cases, the ongoing dietary restrictions are very small when challenges are undertaken in a systematic way.
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Hi, my daughter is 4 1/2 and is experiencing stomach pain (like colic) every night. We have just been to the RCH and have seen a Paediatric Gastroenterologist. Tomorrow we are having a Lactulose Breath Test and a week later a Fructose Breath Test. As a baby we tried numerous formulas as she was very unsettled, windy and colicy. She was far worse on Pepti Junior and Neocate. She settled on plain cows milk so we went with that. I made all her meals, veggies and meat. I felt like the ‘corn’ in formulas was the problem so I tried to eliminate all corn products from her diet. Once she started kinder I made her honey, Vegemite and cheese sandwhiches. She started becoming itchy (bottom/vagina) and a bit of thrush on and off. The paed checked for Celiac -negative. I thought I worked it out that it was the cheese so I stopped that. Symptoms came back. I took her to a Naturopath. She diagnosed a Yeast infection so I followed her advice of no corn/yeast/dairy/table sugar. I found some Organic spelt sourdough bread and organic honey. So her diet consisted of honey sandwhiches, sultanas, fruits like strawberries, watermelon and bananas, almond milk etc. Her symptoms became ten times worse!! Pains every night, sometimes waking 3 times. Very windy. Her behaviour became very irritable esp after a banana or rockmelon. So we are thinking it’s a Fructose Intolerance and probably has been from day one. Would she have an intolerance still to all corn products or would it just be ‘corn syrup and corn sugar’??? Im too scared to try Vegemite (contains corn) or gluten free breads that contain maize. At the moment her diet is meat and veg, rice bubbles and lactose free milk for brekkie, for snacks, mini rice cakes (natural with sea salt) plain smiths chips and lactose free yoghurt. I’ve found even a handful of strawberries sets her off too (at the moment).
ReplyHi Carolyn
Thanks for your comment and sorry to hear of the rough time your daughter has had.
It will be interesting to see the results of the breath tests you are undertaking as the fruits you are noticing to be triggers “banana and rockmelon and strawberries” are not actually fruits containing excess fructose and I would usually encourage children to continue to consume these while following a low fructose diet. Often though, we attribute the pain to the last food consumed, when it may actually be caused by a build up of a range of different things and not that last food eaten.
Please be in touch once you have the results of her tests to determine the most logical plan to help both of you get a whole painfree night’s sleep!
ReplyThank you for your reply. Yesterday I gave her a Gluten free supermarket bought biscuit to try and she became irritable. She had a plain lactose free yoghurt after tea for dessert. She did not scream out in pain last night was was aggitated, restless and I had to give her Panamax. I think her stomach has been so effected by the diet I was giving her based on the naturopath that any sugar/Fructose sets her off. Could this be possible? She had the Breath Test on Saturday and that confirmed she was a hydrogen producer!!! I’m not sure what that means! This Saturday she is being tested for Fructose.
ReplyHi Carolyn. The best thing to do is make an appointment once you have all of the results back from all of the breath tests to work out the best plan for your daughter going forward. I hope Saturday gives you some much needed answers!
ReplyHi there, apparently Neve has Fructose Malabsorption even though we have not got the results as Gastro Lab is off till next week. The lady conducting the test said ‘Yes, absolutely!’ So I’ve been researching low Fructose foods! Some Low Fodmap Foods say one thing and others say different! I’m at the point where I’m not sure if a tiny floret of broccoli reacts or it’s the carrot in her meals! I’m too scared to try Gluten free foods as most contain corn! I have tried giving her Glucose powder to counteract symptoms and twice I feel it has helped!!! The Glucodin is derived from corn!!!! So does that mean she most likely hasn’t got a corn intolerance?!?! I have no idea. Over Christmas it was horrendous!!! I used bacon in some fried rice! Bad idea!!! We are going down to Melbourne next Wednesday the 6th to see a Gastroenterologist again. How do we go about getting an appoint with you?
ReplyHope this works!
ReplyHello,
ReplyMy niece’s 8-month-old baby boy has been diagnosed with silent reflux. They have him on Prilosec.
He does spit up food regularly, but the diagnostic tests have not yet been performed to rule in/out esophageal anomaly as possible cause for food reflux.
The baby has been on a low FODMAP diet as of two weeks ago, and while he’s on lactose-free formula, the formula is not low FODMAP.
I have been searching for low FODMAP baby formula but my searches have been unsuccessful.
Is there a low FODMAP baby formula that you may suggest?
We will be consulting a nutritionist as well, but until we find the right nutritionist in our area, we want to help the baby as much as we can by making him completely low FODMAP.
Thank you for your advice.
Hi Esther
ReplyI am not aware of any FODMAP infant formulas on the market but the lactose free formula should be suitable at this time. If it turns out that she has a suspected cow’s milk protein intolerance though then she will need to see her Paediatrician for a prescription formula.
Hi there,
ReplyWe have done an elimination diet with our nearly 5 year old and we have gone from inititial thoughts of salycilate sensitivity to gluten to finding patterns of fructose and fructans reactions – which has led us to low fodmap.
His symptoms have not been so much physical, by behavioural changes – hyperactivity, inability to reason, loss of control of making good choices etc.
I haven’t found anything apart from physical symptoms linked to fodmap malabsorption. Can there be behavioural symptoms rather than physical symptoms? He is a different kid without fructose and fructans..
thanks
Hi, My daughter is 4 1/2 and has just had her Hydrogen and Lethane Breath Test Results return showing Positive for Fructose Malbsorption and Low Hydrogen levels on Lactose test (which I am not sure what this aspect of the test indicates regarding lactose). Is there a recommended Paediatric Dietician we should be seeing now to assist with her diet?
ReplyThank you
Kerene