A practical approach to dietary interventions in pediatric irritable bowel syndrome

Pediatric irritable bowel syndrome (IBS) is a gut-brain axis disorder that negatively affects the quality of life of children and adolescents. Because up to 90% of children and parents report a direct correlation between the consumption of specific foods and symptom exacerbation, dietary intervention is a therapeutic challenge. However, the lack of nutritional guidance leads parents to self-manage their children's diets, thereby increasing the risk of dietary restrictions and nutritional deficiencies. This review analyzes current evidence on dietary therapy for pediatric IBS, focusing on efficacy, safety, and the risk of nutritional deficiencies. Traditional dietary advice is recommended as the first-line dietary approach, promoting a set of lifestyle and dietary recommendations; it demonstrates long-term clinical efficacy comparable to more restrictive diets while minimizing the risk of eating disorders. The Mediterranean diet serves as a protective and sustainable diet, offering anti-inflammatory effects and favorable microbiota modulation by prebiotic fiber and antioxidant compounds. By contrast, the low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet is reserved for selected cases owing to its restrictive nature and potential for nutritional deficiencies. To date, the gluten-free diet approach remains limited and controversial in children. Moreover, reduction of ultra-processed foods is a further diet strategy for IBS symptoms; ultra-processed foods are often rich in fermentable oligosaccharides, disaccharides, monosaccharides, polyols, and added sugars, leading to microbiota dysbiosis and symptom exacerbation. Overall, a multidisciplinary and family-centered approach is essential to control IBS symptoms in children, focusing on personalized diet and behavioral interventions.