For the study procedure and timeline, see Table 1 and Fig. Fig.1.1. At the initial baseline visit (Visit 0), children will be diagnosed with IBS or FAP-NOS by a gastroenterologist, undergo a growth assessment by a nurse, and have an initial visit with a research dietitian. At the initial dietary consultation, all subjects will receive oral and written information regarding the study. A Monash FODMAP-trained dietitian will educate the caregiver and child about the principles of the study design, as well risks and benefits, during a face-to-face meeting. The subjects will be asked to complete a questionnaire, reflecting the preceding week, including questions about the intensity and frequency of abdominal pain, stool consistency, absence from school, and parents’ absence from work. Baseline scores on the Gastrointestinal Symptom Rating Scale (GSRS) [21], the KIDSCREEN-10 index [22] and the World Health Organization Five Well-Being Index (WHO-5) [18] will also be obtained. The child’s anthropometric measurements will be obtained by an independent nurse (see Growth in Outcome section). The baseline dietary assessment will include a qualitative and quantitative assessment of each child’s usual food intake based on a 3-day food record completed retrospectively, against the Nutrition Standards for the Polish population (2017) [23]. Based on the same food record, the baseline FODMAP intake in each meal also will be calculated using the Monash FODMAP Calculator. The dietitian will perform a thorough interview to tailor the diet to the individual child’s needs [19, 24, 25]. The baseline physical activity level also will be assessed using a Moderate-to-Vigorous Physical Activity (MVPA) screening measure [26].

Participant timeline

Whenever a patient is enrolled, the participant’s case report form (CRF) will be created. Both, the CRF and one copy of the informed consent in paper form will be archived. Data from the CRF will be entered into an electronic database (see Data collection and management section).

Participant will be randomized and allocated to receive the intervention or control diet for 28 days. During the intervention period, the abdominal pain intensity (using the 100-mm VAS score), stool consistency (using the Bristol Stool Form Scale), pain frequency (by reporting the number of episodes/week), school attendance and parents’ work absenteeism (by reporting the number of days of school or work/week missed), and scores on the GSRS, KIDSCREEN-10 index and WHO-5 will be recorded in the subject’s diary each week (see Table Table1).1). For children ≥14 years of age, the study diary will be filled out by themself; for younger children, the diary will be filled out by caregiver. Moreover, the child/caregiver(s) will be reporting the percent of each meal which the subject consumed (< 50%, 50–79% or 80–100%) each day, to estimate the amount of food consumed throughout the trial; the additional snacks consumed also will be reported daily (characteristics and amount). The tolerance of the diet will be assessed each day using a 100-mm VAS and reported in the subject diary. The caregiver and/or participants will be instructed to record in the study diary any observations concerning the health of the child, especially any symptoms which appeared close to a meal. The dietitian will also monitor the subjects’ acceptability of and adherence to the provided diet each week (see Fig. Fig.11).

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