1. Alycia Leiby, MD*,† 2. Minal Vazirani, MD‡,¶ 1. *Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Goryeb Children’s Hospital, Atlantic Health System, Morristown, NJ. 2. †Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA. 3. ‡Siegler Center for Integrative Medicine, Barnabas Health ACC Barnabas Health System, Livingston, NJ. 4. ¶Rutgers – New Jersey Medical School, Newark, NJ. Irritable bowel syndrome (IBS) occurs commonly in pediatrics, with the prevalence estimated at 6% to 14%. (1)(2) The Rome criteria define pediatric IBS as abdominal pain that improves with defecation and/or onset associated with a change in frequency or form of stool. (3) In addition, no evidence of an inflammatory, anatomic, metabolic, or neoplastic process explains the symptoms. The cause of IBS is attributed to a combination of factors, including an altered gut microbiome, low-grade mucosal inflammation, visceral hypersensitivity, abnormal motility, psychosocial stressors, and genetic predisposition. (4) Recognition of these factors serves as the foundation for the biopsychosocial approach to treating pediatric IBS. A successful treatment plan starts with a strong patient-parent-physician relationship in which the child’s pain is validated and the physician compassionately approaches the distress that IBS can cause. Multiple studies have shown that children with IBS have a lower quality of life (QOL) that is comparable to that seen with nonfunctional gastrointestinal conditions. (2)(5) Conventional treatment includes education and reassurance, cognitive behavioral therapy (CBT) for some patients, and consideration of antispasmodic or antidepressant medications. In practice, the lack of strong evidence, potential for adverse effects, and parental concern limit the utility of conventional pharmacologic options. Complementary and alternative medicine (CAM) use in pediatric gastroenterology is common and higher in patients with IBS than nonfunctional gastrointestinal conditions. (6) This article reviews the evidence for CAM therapy in IBS based on adult and pediatric data available in the English language. The World Health Organization defines probiotics as “live micro-organisms which, when administered …