Dietary advice for children and young people with common gastro-intestinal symptoms

Patient/Parent/Carer information

Your doctor has provided this leaflet as you/your child has symptoms of abdominal pain, loose stools and/or bloating and they feel a change in diet may improve these symptoms.

What is the dietary treatment?

Foods containing fibre are generally recommended as part of a healthy diet. However, foods which are high in fibre, sugar or caffeine can lead to loose stools, bloating and abdominal pain. Changing the types of foods you/your child eats and drinks may improve these symptoms. You may find it useful to keep a symptom diary during this time to see whether the changes you have made have helped.

Meal routine

Following a meal and snack routine can help symptoms. We recommend:

• Three regular meals per day
• Eat sitting at a table where possible
• Take your time to eat, putting your cutlery down between mouthfuls. A meal should last about 15 minutes
• Don’t eat late at night or too close to bedtime
• Avoid skipping meals

Sugars and Sweeteners

Sugar can reach the large bowel undigested, which can then be used as fuel by the good bacteria in the bowel. This can lead to symptoms of bloating, abdominal pain and/or loose stools. The amount of sugar that you can tolerate varies from person to person.

Fruit contains natural sugar (fructose). You may find it helpful to have only one portion at a time and limit fruit to two portions per day (one portion is a child’s fistful). Ideally choose favourable fruits that contain less fructose (see below). Avoid fruit juices, smoothies and dried fruits as they contain high levels of fructose.

Refined sugars in your/your child’s diet (fizzy drinks, squashes, sweets, chocolate and table sugar added to foods such as breakfast cereals) often contribute to symptoms. Reducing the amount of these you/your child eats may be beneficial. You do not need to be on a sugar-free diet but keep the amounts within normal healthy eating guidelines.

Sweeteners, particularly sorbitol, isomalt, lyasin, xylitol can also contribute to symptoms and should be reduced. These are often in foods such as low-calorie squash, yogurts, sweets/mints and chewing gum.

Vegetables

Some vegetables can cause bloating and wind and others are very high in fibre. Reducing these unfavourable vegetables may help (see table below) and favourable vegetables can be used to boost you/your child’s fruit and vegetable intake. Aim for five age-appropriate (your child’s fist size) portions per day.

Fluid

Excessive drinking can also cause diarrhoea. Children and young people need plenty of fluid, but some like to drink almost constantly. This is often more for comfort or habit than because of thirst. It is a good idea to plan set times for drinks, such as with meals and snacks, and not to offer drinks in between.

It is recommended that children and young people need six to eight glasses per day, with younger children needing smaller drinks (120-150ml) and older children and young adults needing larger drinks (250-300ml). They may need more in hot weather or if they are unwell.

We recommend that children / young people drink water in preference to other sweetened drinks. Fizzy drinks and drinks containing caffeine (such as cola, energy drinks, tea and coffee) can also lead to increased symptoms. Caffeine is not recommended for young children and energy drinks are not advised for those under 16 years of age.

Fibre

Foods containing fibre are encouraged, however some children and young people often cannot tolerate high fibre foods very well and excessive fibre consumption should be avoided.

High fibre foods include high fibre breakfast cereals, flapjacks, and wholewheat products, such as brown rice, wholemeal bread and wholewheat pasta. It is recommended that these are reduced, by swapping some of these products for their refined versions.

Fat

Foods very high in fat can slow down the movement of foods in the gut, increasing abdominal pain. Fatty foods include fatty meats (sausages and burgers), chips, fast foods, creamy sauces, deep fried foods, pizza, crisps, cakes, nuts, biscuits and rich desserts such as cream cakes, ice cream and crème caramel. If you or your child eat these foods daily, reducing them may help.

Spicy foods

Spicy foods (such as curries, chilli con carne) may worsen symptoms of abdominal pain and reducing them may help in some people.

Do I / Does my child always need to eat like this?

We expect these dietary changes to improve symptoms within one month. If after one month you/your child have no improvement, then the symptoms are unlikely to be related to these dietary triggers and you should continue to eat a healthy, balanced diet.

If the dietary changes improve your/your child’s symptoms then it is worth continuing them. A person’s tolerance of these foods can change with time. You may find it useful to reintroduce some unfavourable fruit and vegetables and high fibre foods every so often in small quantities, increasing if tolerated well.

What if I have questions?

This dietary advice sheet gives some general information to help you make the recommended changes to your child’s diet.

If you have any questions about the nutritional value of your child’s diet or if your child is following a special diet that makes it difficult for you to make these changes, please contact your GP who can refer your child to a dietitian at your local hospital or in the community.

Additionally, if you have any other questions that the leaflet does not answer or would like further explanation, please contact your GP for further advice. They may also then wish to offer an onward referral to a dietitian at your local hospital or in the community.