Case Study Part 1

An 8 year old boy called Max came to visit the practice with his mother.

The main complaint is recurrent abdominal pain, he has been to the doctor 3 times over the past 6 months about this. Their GP did blood screening, including a coeliac screen, Full Blood Count,  serum glucose, urine and faecal calprotectin – all the results were in normal ranges . He continues to grow and gain weight satisfactorily.

His mother wants him to have a ‘scan’ as ‘ something must be wrong’

These episodes are affecting his school attendance and causing stress at home.

Max is anxious about going to friends homes and prefers to staty at home than socialise .

Examination revealed  a systemically well child with a soft abdomen.

Symptoms scores for abdominal pain, flatulence and repeated diarrhoea are marked as severe by the parent on the symptom scoring chart. The diarrhoea amounts to 4-5 loose but not watery stools throughout the day.

Defecation does not ease the pain for very long.

The GP has ruled out organic pathology and diagnosed IBS-D , he has reassured the parents and suggested a visit to the dietitian as a starting point .

He has prescribed Iberogast and simple analgesic to be used during flare-ups.

Initial dietary history

Max  is generally a picky eater sometimes skipping meals but has a good appetite and often asks for snacks.

Breakfast :  often skips as no time in morning, sometimes ½ banana on way to school. Occasionally cereal (rice crispies, cheerios or similar with milk)

Lunchbox :

Cold sausages/ Vienna/ babybel cheese/ chicken drumstick

Sandwhich – brown bread with peanut butter/ cheese/ jam

Chopped up fruit

Something sweet – dried fruit sticks, date bars, cereal bars , peanuts and raisins etc

He will come home with an empty lunchbox


Fruit juice with sweet biscuits, Chelsea bun, fruit or chips


What the family has, but often picks at his food eating very small portions

Fruit juice to drink

Fruit and yoghurt dessert

Evening snack :

Fruit and nuts and milky drink

He drinks up to 1500ml water or juice throughout the day.