An Integrative Medicine Approach to SIBO in Pediatrics: Testing, Diagnosis, and Treatment Options

It's vital to establish and maintain good gut health beginning in early childhood. Establishing vibrant gut health entails ensuring your children's microbiome is in good standing. A dysfunction in gut flora can lead to SIBO, which can be painful and uncomfortable for a child. Small Intestinal Bacterial Overgrowth resembles other functional gastrointestinal disorders and should therefore be thoroughly evaluated and tested for appropriate diagnosis.  

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What is SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) is when the small intestines have an abundance of bacteria that has dominated the microflora. Bacteria are a normal component of the human microbiome, but there is a delicate balance between the types and quantity of bacterial species. In terms of bacteria in the gut, the large intestines harbor the majority of bacteria. But in the case of SIBO, the small intestines have more bacteria than the large intestines. When this disproportion occurs, dysfunction can occur, and symptoms will arise from the side effects of the microbial imbalance.

SIBO Symptoms in Pediatrics

Distinguishing the symptoms of SIBO is important, as it can resemble other gastrointestinal conditions. Often SIBO will co-occur with other underlying gut disturbances, in which case, here are some of the symptoms you could experience:  

• Bloating
• Fullness with discomfort after eating
• Indigestion
• Gas
• Diarrhea or constipation
• Fatigue
• Weakness
• Loss of appetite
• Nausea
• Stomach pains
• Unintentional weight loss

What Causes SIBO in Pediatrics?

Bacterial overgrowth in the small intestines can occur for several reasons. Here are the top causes of SIBO in children.

Small Intestinal Motility Dysfunction

Muscle weakness or lack of proper nerve signaling to the small intestines can cause dysmotility. When the smooth muscle of the small bowel is not contracting to move food along, or the brain is not sending proper signals for the intestinal muscle to contract, food can become stagnant. When food and digestive waste remains too long, bacteria can overpopulate and, as a result, causes SIBO.

Low Stomach Acid (Hypochlorhydria)

When the stomach does not make enough stomach acid to break down food, that can impact the child's digestive tract. Hypochlorhydria also inhibits the use of proteins to help protect against bacteria and viruses, which is important in preventing health concerns like SIBO. A low stomach acid presentation can be due to both Helicobacter pylori (H. pylori) and SIBO. Determining which condition is occurring, or if it is a concomitant infection, is possible through clinical evaluation and appropriate testing.

Small Intestinal Structural Issues

Anatomical abnormalities within the walls of the gastrointestinal tract can lead to various health issues, one of them being SIBO. Complications from a GI surgery or a gastrointestinal disease such as diverticulosis can create changes in the small intestines that make it hard for food particles to be properly digested. Food may hide in crevices of intestinal folds, in which bacteria will then be attracted and lead to replication and overgrowth of those pathogens.

Medications

Certain medications may cause a disturbance in the gut microbiome which can lead to SIBO. Antibiotics are one type of medication that is non-discriminatory and can kill off both good and bad bacteria. When the good bacteria are eradicated, an environment for pathogenic bacteria to overpopulate can occur, causing a disturbance to the gut flora. Proton pump inhibitors, used to treat conditions like GERD, can be a risk factor in developing SIBO due to prolonged decrease of stomach acid.

How To Diagnose SIBO in Pediatrics?

Some conventional doctors and most holistic health practitioners utilize breath tests to diagnose SIBO. In addition to this, imaging of the gastrointestinal tract can provide valuable information.

SIBO Breath Test

The Hydrogen Breath Test is the most commonly used test to diagnose SIBO. This test requires the child to drink a high-glucose or lactulose solution provided by the lab. The bacteria in the small intestines will respond to this solution, creating byproducts that are then measured through their exhaled breath. After drinking the solution, your child will breathe into a series of bags that capture their exhaled breath at set time intervals. Commonwealth Diagnostics International offers a pediatric-specific test that investigates both hydrogen-associated Small Intestinal Bacterial Overgrowth (SIBO) and Intestinal Methane Overgrowth (IMO), which is a great option due to the overlapping features that these gases produce. This SIBO/IMO Lactulose Breath Test is a pediatric-specific at home-test that, when done properly, can provide valuable insight.

Imaging for SIBO

As a screening tool, imaging can be useful. CT scans, MRIs, or X-rays may be utilized to evaluate anatomical structures of the bowels. This can provide insight into bowel impaction, narrowing of the bowel that is related to dysmotility, or dilated loops in the bowel. Imaging is not specific for SIBO but provides context to the status of the intestinal structure.

Functional Medicine Labs That Can Help Individualize Treatment for Pediatrics With SIBO

SIBO can cause dysfunction in the child's health and wellness. Without proper absorption of nutrients or waste excretion, deficiencies and inflammation can occur within the gastrointestinal tract. Here are additional tests that can help direct a comprehensive treatment plan.

Micronutrient Testing

When pathogenic bacteria take over the small intestinal microbiome, there is a breakdown of digestion, absorption, and assimilation of nutrients. Obtaining a micronutrient panel can help determine what vitamins and minerals support your child's needs during their healing. SpectraCell's Micronutrient Test assesses nutritional status 31 vitamins, minerals, metabolites, amino acids, and antioxidants.

Stool Analysis

Obtaining a stool sample for screening purposes will help rule out common concomitant GI pathogens like Candida. Access Medical Laboratories offers a Comprehensive Stool Analysis, which can detect some of the most common gut pathogens that lead to dysbiosis.

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Integrative Medicine Treatment for SIBO in Pediatrics

Addressing SIBO from a conventional and complementary medicine route often results in complete elimination and recovery to health. Here are some evidence-based holistic medicine approaches to treat SIBO:

SIBO Diet

There are five diet protocols in the functional medicine paradigm that are implemented to address SIBO. These diets are low FODMAP, Specific Carbohydrate Diet (SCD), SIBO bi-phasic diet, Gut and Psychology Syndrome Diet (GAPS), and the Elemental Diet. While each has a time and a place, depending on where an individual is, there are two main options regarding the practicality of treating children with SIBO. A low FODMAP or an SCD, while restrictive, is the least restrictive when it comes to dietary interventions. As stated in the linked article, there is clinical evidence of success in using SCD to treat celiac disease in children. This diet requires the elimination of carbohydrates that contain excessive sugar and hard-to-digest carbohydrates, including sucrose, fructose, molasses, cane sugar, grains, lactose dairy products, a variety of legumes, processed food items, candies, and foods that contain fructooligosaccharides. Foods that are encouraged on this diet include meat, poultry, fish, shellfish, eggs, no added sugar nuts, select cheeses, fresh or frozen fruits, and vegetables without added sugar, and select legumes like lentils and honey.

Much like the Specific Carbohydrate Diet, the low FODMAP diet has successfully treated pediatric gastrointestinal disorders like IBS. Symptoms of IBS and SIBO cross over and thus should provide symptom relief for kids being treated for SIBO. The recommended duration for this diet is 2 to 6 weeks, two weeks being the most practical. This diet consists of an elimination phase and a reintroduction phase. During the elimination phase, the child should eliminate all high Oligosaccharides (Fructans and galacto-oligosaccharides (GOS)), Disaccharides: (lactose), Monosaccharides (Fructose), and Polyols (Sorbitol and mannitol). Examples of Low FODMAPS foods that are encouraged in this diet include strawberries, blueberries, cantaloupe, greens, cucumbers, potatoes, cheeses, eggs, poultry, meat, gluten-free grains, spelt, macadamia nuts, pumpkin seeds, and walnuts. Foods to be eliminated during the minimum two-week phase include but are not limited to apples, pears, honey, mango, fruit juices, cows milk, yogurt, heavy cream, avocado, apples, peaches, mushroom, cauliflower, garlic, wheat, cashews, hummus, and lentils.

Antibacterial Botanicals for SIBO

There are two common herbal medicines that are used for their antibacterial properties to treat SIBO and are safe in pediatrics.

Allicin: which is an active constituent in garlic, has shown positive results in treating bacterial lung infections. It has been used clinically as an integrative approach to killing the bacteria involved in SIBO. This safe botanical for kids should be taken at a dosage using Clark's Rule, which is the child's weight divided by 150, then multiplying that fraction by the recommended adult dose. The recommended dosing for Allicin in adults is 450-900mg three times per day.  

Oil of Oregano: is in a variety of supplement compounds used in the treatment of SIBO. For kids, it can be used topically or as a very diluted dosing in water. Carvacrol is a constituent of Oregano and has shown to be valuable as an antibacterial agent, biofilm buster, and quorum sensor. Oregano should be recommended and dosed by a holistic doctor who understands the mechanisms of action and how it will benefit the patient.

Supplements and Herbs for Gut Motility

Magnesium: is responsible for over three hundred enzymatic processes in the body. One is nervous system input and pro-motility roles in the gastrointestinal tract. There are eight types of magnesium, each having a unique purpose. One beneficial form of magnesium to combat constipation is Magnesium Oxide. Research has shown that it can stimulate motility due to the intestinal stimulation that occurs when Magnesium Oxide enters the stomach.

Ginger: has been looked at for the many benefits it has for dyspepsia, nausea, and bloating. In recent studies, it has also been considered an agent for gut motility. One study found that ginger can positively affect gastric motor function. When healthy volunteers were given three ginger capsules 1 hour after a light meal, there was an increase in the frequency of antral (stomach) contractions and a decrease in gastric emptying time. Using ginger at a child-appropriate dose has great potential as a motility agent in cases of SIBO.

Acupuncture and Acupressure for Gut Motility

The use of this Traditional Chinese Medicine practice can effectively modulate gastric motility. Evidence reveals that acupuncture at the ST-36 and neiguan (PC-6 point) both decreased motility stimulation and increased motility depending on what the individual needed. For younger kids, gentle acupressure is a great adjunctive at-home modality. The main point for stomach innervation, which can help with GI pains, constipation, and vomiting, is stomach 36 (Zu San Li).

Exercise for Gut Motility

Movement has exponential benefits for children, including supporting a healthy gut. The literature states that exercise can improve the microbiome by increasing good bacteria. Movement activates the muscle of the small intestines, which helps with the contraction and migration of the bacteria out of the small intestines. While younger kids tend to be pretty active, it is especially important to encourage your children to get outside and move their bodies for overall health and wellness.

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Summary

Small Intestinal Bacterial Overgrowth can disrupt anyone's health, particularly young children whose microbiome is still developing. Gathering important clinical information, obtaining the appropriate imaging, and creating an individualized treatment plan can help eradicate the pathogenic bacteria and re-establish gut health. As part of the healing journey, education on preventative gastrointestinal support should be provided so the child has a decreased chance of relapse and their gut health continues to flourish.