J Pediatr Gastroenterol Nutr. 2022 Sep 1;75(3):356-368.doi: 10.1097/MPG.0000000000003526. Epub 2022 Aug 9.

R A Thomassen ¹, V Luque ², A Assa ³, O Borrelli ⁴, I Broekaert ⁵, J Dolinsek ⁶, J Martin-de-Carpi ⁷, E Mas ⁸, E Miele ⁹, L Norsa ¹⁰, C Ribes-Koninckx ¹¹, M Deganello Saccomani ¹², M Thomson ¹³, C Tzivinikos ¹⁴, E Verduci ¹⁵, J Bronsky ¹⁶, N Haiden ¹⁷, J Köglmeier ¹⁸, B de Koning ¹⁹, M A Benninga ²⁰

Author information

¹From the Department of Paediatric Medicine, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway.

²Paediatric Nutrition and Development Research Unit, Serra Hunter Fellow, Universitat Rovira i Virgili-IISPV, Spain.

³The Juliet Keidan institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel.

⁴the Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK.

⁵the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

⁶the Department of Paediatrics, University Medical Centre Maribor, Maribor, Slovenia.

⁷the Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain.

⁸Service de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse, Toulouse, France; IRSD, Université de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France.

⁹the Department of Translational Medical Science, Section of Paediatrics, University of Naples "Federico II", Naples, Italy.

¹⁰the Department of Paediatric Hepatology, Gastroenterology and Transplantation ASST Papa Giovanni XXIII, Bergamo, Italy.

¹¹Paediatric Gastroenterology, Hepatology & Nutrition, La Fe University Hospital & Instituto de Investigacion Sanitaria La FE, Valencia, Spain.

¹²the Department of Paediatrics, Woman's & Child's University Hospital of Verona, Italy.

¹³Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UKthe.

¹⁴Department of Paediatric Gastroenterology, Al Jalila Children's Specialty Hospital, Mohammed Bin Rashid University Of Medicine and Health Sciences, Dubai, UAE.

¹⁵the Department of Pediatrics, Ospedale dei Bambini Vittore Buzzi, University of Milan, Italy.

¹⁶the Department of Paediatrics, University Hospital Motol, Prague, Czech Republic.

¹⁷the Department of Clinical Pharmacology, Medical University of Vienna, Austria.

¹⁸the Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UKthe.

¹⁹Department of pediatric gastro-enterology, ErasmusMC Sophia Children's Hospital, Rotterdam, The Netherlands.

²⁰the Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands.

Abstract

Excluding oligo-, di-, monosaccharides and polyols (FODMAPs) from the diet is increasingly being used to treat children with gastrointestinal complaints. The aim of this position paper is to review the available evidence on the safety and efficacy of its use in children and provide expert guidance regarding practical aspects in case its use is considered . Members of the Gastroenterology Committee, the Nutrition Committee and the Allied Health Professionals Committee of the European Society for Pediatric Gastroenterology Hepatology and Nutrition contributed to this position paper. Clinical questions regarding initiation, introduction, duration, weaning, monitoring, professional guidance, safety and risks of the diet are addressed. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. The systematic literature search revealed that the low-FODMAP diet has not been comprehensively studied in children. Indications and contraindications of the use of the diet in different pediatric gastroenterological conditions are discussed and practical recommendations are formulated. There is scarce evidence to support the use of a low-FODMAP diet in children with Irritable Bowel Syndrome and no evidence to recommend its use in other gastrointestinal diseases and complaints in children. Awareness of how and when to use the diet is crucial, as a restrictive diet may impact nutritional adequacy and/or promote distorted eating in vulnerable subjects. The present article provides practical safety tips to be applied when the low-FODMAP diet is considered in children.