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Key takeaways
- A gut-brain disorder is a positive diagnosis in a young person, not a diagnosis of exclusion.
- Naming it early and confidently reassures anxious adolescents and their families.
- A fecal calprotectin of 50–120 rarely means IBD in an adolescent.
- Gut-directed hypnotherapy has the strongest evidence of any treatment for IBS and functional gut pain in patients aged 4–18.¹
The clinical challenge with adolescent IBS
Gut-brain disorders in children and adolescents – recurrent tummy pain, nausea, or IBS with normal investigations – are best managed by making the diagnosis early and positively, limiting unnecessary tests, and treating the gut-brain mechanism directly with therapies such as gut-directed hypnotherapy.¹ The evidence points away from repeated investigation and toward earlier behavioral treatment.
The hardest part is rarely the medicine; it's the conversation with an anxious family who came expecting a scan. This guide draws on a clinical education webinar with pediatric gastroenterologists Dr. Charmaine Chai and Dr. Paul Hammond of the Women's and Children's Hospital, Adelaide.
How to investigate abdominal pain in children and adolescents
The first judgment is separating the acute abdomen that needs action today from the chronic pain that needs a plan. A febrile, tachycardic, guarding young patient belongs in the same-day pathway; appendicitis is the miss you cannot afford. Once that's excluded, the pace changes: you can sit, think, and talk to the family rather than reach for the next test.
For the chronic presentation, let red flags – not parental anxiety – decide how far to investigate.
Celiac serology and fecal calprotectin are reasonable early steps; a colonoscopy in a well adolescent, requested "while she's having an anesthetic anyway," usually is not.²
What does a borderline fecal calprotectin mean in a child?
A fecal calprotectin between 50 and 120 is the result that drives the most unnecessary escalation. In children, calprotectin discriminates inflammatory bowel disease from a gut-brain disorder well at higher values, but its specificity is limited in the borderline range, where transient causes are common.³ Genuine, untreated IBD in a young person would be unusual with a value this low.
"It's where the calprotectin disagrees with your clinical impression that I find is an individual nuance." – Dr. Paul Hammond, Pediatric Gastroenterologist, Women's and Children's Hospital, Adelaide, Australia
The practical rule: interpret calprotectin against your pre-test suspicion, and when a borderline result disagrees with an otherwise reassuring picture, repeat it before acting. A recent gastro bug or a dose of ibuprofen can push it up transiently. Framing this for parents before you send the test stops a borderline number triggering panic later.
How to explain IBS and gut-brain disorders to families
This is where clinicians win or lose the consultation. The instant parents hear "brain," many hear "it's all in her head" – often because a previous clinician left them with exactly that impression.
Name it early and name it positively. A gut-brain disorder is not a diagnosis of exclusion or a psychiatric label; it reflects real, measurable changes in visceral sensitivity, motility, and bidirectional gut-brain signaling.⁴ Meeting the "it's all in his head" objection head-on, before it's raised, tends to lift a visible weight from the family.
"I usually say to people, I'm not at all saying it's in your head, and that's not what this is. What this is, it's the combination of things – and what's really important is for us to rule out is this a problem of the lining." – Dr. Charmaine Chai, Pediatric Gastroenterologist, Women's and Children's Hospital, Adelaide, Australia
Point out what's reassuring, too. Stable weight, and a bowel habit that swings between constipation and diarrhea, both argue against inflammation and help a family accept the diagnosis.
Adolescent patient resource
Share this downloadable brochure that helps teenagers and their families get started with Nerva gut-brain therapy.
Share with your patients
More patient resources to read and share are at nervahealth.com/blog
What treatments work for IBS and functional gut pain in young people?
Start by being honest about what the evidence supports. In the recent large pediatric trial, peppermint oil was no more effective than placebo for abdominal pain in young people, echoing earlier signals that no pharmacological option clearly outperforms placebo in this group.⁵ ⁷ That doesn't make a harmless, low-stakes ritual worthless – a bedtime peppermint tea can help – but it should be framed as supportive, not curative.
The strongest evidence sits with gut-brain psychotherapies. In the 2025 ESPGHAN/NASPGHAN guidelines, gut-directed hypnotherapy showed the strongest evidence and effect size of all the treatments reviewed for IBS and functional abdominal pain in patients aged 4 to 18.¹ For families weighing another test against active treatment, that is worth stating plainly.
Does gut-directed hypnotherapy work for adolescent IBS?
Gut-directed hypnotherapy suits younger patients partly because it doesn't demand full cognitive buy-in.
"A lot of them are sort of pre-contemplative around what's going on, and using hypnotherapy sort of bypasses that need to have full engagement from the patient."
– Dr. Mark Salvatore, Pediatric Gastroenterologist, Mass General Brigham for Children
Delivery can be low-stakes: a hypnotherapy audio done at home has been shown to work as well as individual therapist-led sessions in young people with functional abdominal pain and IBS, which matters where access to a trained therapist is limited.⁶ For adolescents specifically, app-based programs such as Nerva (a gut-brain therapy program for ages 14 and over) deliver structured gut-directed hypnotherapy in a format that fits a teenager's routine; in younger children, guided, parent-led options fit best.
Why family is key to managing adolescent IBS and gut-brain disorders
In pediatrics you are treating a system, not a patient. You rarely move a young patient without first moving the parent; get the family believing the diagnosis and you're most of the way there.
"Ultimately, come back to our creed, which is do no harm. If you think that an intervention or an investigation might lead you down that pathway of harm, don't do it – and have very frank conversations around why you're not doing it." – Dr. Paul Hammond, Pediatric Gastroenterologist, Women's and Children's Hospital, Adelaide
Set expectations honestly – gut-directed hypnotherapy is not a magic wand but should meaningfully settle symptoms – and give it six to eight weeks before reassessing.
When the questions escalate – gastroparesis, POTS, MCAS, requests for more scans – three principles keep you on safe ground:
- Address each concern rather than dismissing it, but don't feel obliged to investigate every one.
- Escalate to a general pediatrician or multidisciplinary team early when symptoms are disabling.
- Remember that doing no harm sometimes means not ordering the next test.
Watch the full webinars
Go deeper with two clinical education sessions on managing gut-brain disorders in young people.
Beyond the guidelines: Pediatric GI decision-making
Dr. Charmaine Chai and Dr. Paul Hammond, pediatric gastroenterologists at the Women's and Children's Hospital in Adelaide, work through three real cases – from the acute abdomen to the anxious family – and the judgment calls behind each.
Managing pediatric patients with gut-brain disorders
Dr. Mark Salvatore, Founder and Clinical Director of the Pediatric Mind-Body Medicine Program at Mass General for Children and Assistant Professor of Pediatrics at Harvard Medical School, on recognizing and managing young people who present with gut-brain disorders like IBS.
Frequently asked questions
How do you diagnose a gut-brain disorder in children and adolescents?
Diagnosis rests on the Rome IV symptom criteria plus a reassuring examination, with targeted tests only where red flags are present.⁴ The label should be given as a positive, confident diagnosis at the first consultation rather than deferred until every other possibility has been excluded.
What faecal calprotectin level suggests IBD rather than a functional cause in a young person?
Values well above the borderline range point more strongly toward inflammatory bowel disease, while results between 50 and 120 have limited specificity and are often transient.³ Repeating a borderline result after a few weeks, rather than escalating straight to colonoscopy, avoids unnecessary invasive investigation.
Does peppermint oil work for abdominal pain in children?
Recent randomized trial evidence found peppermint oil was no more effective than placebo for pediatric abdominal pain.⁵ It may still be used as a harmless, low-risk comfort measure, but families should not be told it is a proven treatment.
Can teenagers do gut-directed hypnotherapy at home?
Home-based, self-directed gut-directed hypnotherapy has been shown to be as effective as therapist-led sessions in young people with IBS and functional abdominal pain.⁶ This makes app-based delivery a practical option for adolescents where trained therapists are scarce or waitlists are long.
References
- Groen J, Gordon M, Chogle A, et al. ESPGHAN/NASPGHAN guidelines for treatment of irritable bowel syndrome and functional abdominal pain-not otherwise specified in children aged 4–18 years. J Pediatr Gastroenterol Nutr. 2025;81(2):442-471.
- Hyams JS, Di Lorenzo C, Saps M, et al. Functional disorders: children and adolescents. Gastroenterology. 2016;150(6):1456-1468.
- Henderson P, Anderson NH, Wilson DC. The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109(5):637-645.
- Thapar N, Benninga MA, Crowell MD, et al. Paediatric functional abdominal pain disorders. Nat Rev Dis Primers. 2020;6:89.
- Vermeijden NK, Bodelier A, Cnossen VM, et al. Peppermint oil and sweets in pediatric irritable bowel syndrome and functional abdominal pain: a randomized trial. Clin Gastroenterol Hepatol. 2026 (in press).
- Rutten JMTM, Vlieger AM, Frankenhuis C, et al. Home-based hypnotherapy self-exercises vs individual hypnotherapy with a therapist for children with functional abdominal pain or irritable bowel syndrome. JAMA Pediatr. 2017;171(5):470-477.
- Kline RM, Kline JJ, Di Palma J, Barbero GJ. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001;138(1):125-128.
- Peters SL, Gibson PR, Halmos EP. App-delivered gut-directed hypnotherapy program, Nerva, improves gastrointestinal symptoms and psychological outcomes in pediatric populations: a retrospective audit. JPGN Reports. 2024;5(4).
