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    Rome IV Diagnostic Criteria for Child Irritable Bowel Syndrome (IBS)

    Official Rome IV criteria for the diagnosis of child irritable bowel syndrome (IBS).


    Use in a child or adolescent with symptoms suggestive of irritable bowel syndrome (IBS), such as chronic and recurrent abdominal pain related to defecation and/or changes in stool frequency or form for at least 2 months.   

    Patients with any of the following alarm features must be evaluated clinically for other diagnoses even though IBS may be present:

    • Family history of inflammatory bowel disease, celiac disease, or peptic ulcer disease.

    • Persistent right upper or right lower quadrant pain.

    • Dysphagia.

    • Odynophagia.

    • Persistent vomiting.

    • Gastrointestinal blood loss.

    • Nocturnal diarrhea.

    • Arthritis.

    • Perirectal disease.

    • Involuntary weight loss.

    • Deceleration of linear growth.

    • Delayed puberty.

    • Unexplained fever.

    When to Use
    Why Use

    Patients presenting with symptoms suggestive of IBS for at least 2 months. The diagnosis of IBS should be made by clinical history, positive symptom criteria, physical examination, and minimal laboratory tests. Additional testing should be done only if clinically indicated.

    • Irritable Bowel Syndrome (IBS) is a positive diagnosis and not a diagnosis of exclusion. It is a clinical diagnosis and extensive testing in the absence of alarm signs is rarely indicated.

    • IBS is divided into subtypes, which are determined based on the presence of abnormal stool consistency using the Bristol Stool Form Scale. Alternating bowel habits between diarrhea and constipation are common, and subtypes can change over time.

    • The initial differentiation between IBS with constipation (IBS-C) and functional constipation can be difficult given that the majority of children with functional constipation report abdominal pain (75%). Therefore, it is recommended to treat patients with constipation and abdominal pain for constipation first. If the pain resolves, the patient has functional constipation. If the pain does not resolve with appropriate constipation treatment alone, the patient likely has IBS-C. Repetitive and unnecessary clean-outs should be avoided.

    • In IBS-C it is essential to address the pain resulting from visceral hypersensitivity as part of the treatment plan as well as treatment of constipation. 

    • IBS can coexist with organic disease. For example, patients with Inflammatory Bowel Disease who are in full clinical and histologic remission can have persistent gastrointestinal symptoms related to IBS.

    • For postmenarchal adolescent girls, the abdominal pain should not exclusively occur during their menstrual period.

    • Symptoms related to IBS adversely affect the quality of life in all patients. Psychological stress including anxiety and depression can be both the cause or result of the gastrointestinal symptoms.

    • Used to establish the diagnosis of IBS in patients who present with abdominal pain and altered bowel habits. 

    • Making a diagnosis will help avoid unnecessary testing and allows for targeted treatment more quickly. 

    • Can be used to discuss the diagnosis of IBS with patients and initiate appropriate treatment.

    Must have the following:

    For ≥2 months prior

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Creator Insights
    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    Dr. Lin Chang

    About the Creator

    Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.

    To view Dr. Lin Chang's publications, visit PubMed

    The Rome Foundation

    About the Creator

    The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.

    Committees Chair Co-Chair
    Esophageal Disorders Ronnie Fass, MD John Pandolfino, MD
    Gastroduodenal Disorders Nicholas J. Talley, MD, PhD, FRACP Vincenzo Stanghellini, MD
    Bowel Disorders Fermin Mearin, MD Brian Lacy, MD, PhD
    Gallbladder and Sphincter of Oddi Disorders Grace Elta, MD Peter Cotton, MD
    Centrally Mediated Disorders of Gastrointestinal Pain Peter J. Whorwell, MD Laurie Keefer, PhD
    Anorectal Disorders Adil E. Bharucha, MD, MBBS Satish S. C. Rao, MD, PhD, FRCP
    Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Sam Nurko, MD Marc A. Benninga, MD
    Childhood Functional Gastrointestinal Disorders: Child/Adolescent Carlo Di Lorenzo, MD Jeffrey S. Hyams, MD

    Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs

    Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.

    To view The Rome Foundation's publications, visit PubMed

    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH