Gut check-up for children & teenagers – stool test for children

Calprotectin is a protein from white blood cells. If it rises in stool, this can indicate inflammation in the gut; the value is used to distinguish inflammatory from non-inflammatory gut complaints (PubMed 31088326).

In children, one feature is important: healthy babies and toddlers have much higher values than older children. A meta-analysis found mean values of around 240–260 µg/g in the first six months of life and around 34 µg/g at three to four years (PubMed 40525108). A value above the adult reference range is therefore not automatically abnormal in a young child; interpretation belongs with a paediatrician.

Zonulin is a protein that can loosen the connections between the cells of the intestinal lining; it is measured as a marker of the gut barrier ("leaky gut") (PubMed 21248165). The value is disputed because a widely used assay detects related proteins rather than zonulin itself (PubMed 29459849).

Secretory IgA (sIgA) is the most important antibody of the mucous membranes and binds pathogens in the gut (PubMed 21975936). A high value can indicate an activated mucosal defence, a low value a weaker one. Both values are indications, not a diagnosis. In addition there is alpha-1 antitrypsin, which rises with protein loss via the gut (PubMed 20571826).

Histamine is formed in the gut, among other things by bacteria, and occurs in foods such as aged cheese, sausage or sauerkraut. It is broken down mainly by the enzyme diamine oxidase (DAO) in the intestinal lining (PubMed 33921522).

An elevated value in stool shows that there is a lot of histamine in the gut. Whether this contributes to your child's complaints cannot be read from the stool value alone.

Yeasts such as Candida albicans are part of the normal gut flora in small amounts in many healthy people (PubMed 36135388). The report shows whether Candida species, Geotrichum and moulds are detectable and in what amount.

More yeasts can occur, for example, after antibiotic treatment. Detection alone is not a disease; a distinct "Candida syndrome" is not scientifically established.

The laboratory determines the gut flora by culture and states the bacterial count per gram of stool: aerobic bacteria such as E. coli and enterococci and anaerobic ones such as Bifidobacterium, Bacteroides, Lactobacillus and clostridia. Faecalibacterium prausnitzii and Akkermansia muciniphila are measured by molecular methods.

Bifidobacteria are especially characteristic of the gut flora of infants; with complementary food and increasing age, the gut flora becomes more diverse and more similar to that of adults (PubMed 29118049). The laboratory's reference ranges do not fit every age equally well; the results consultation puts the values into context.

The digestion values show how much fat, nitrogen, sugar and water remain in the stool, plus pancreatic elastase as a pancreatic enzyme and bile acids. If a lot of fat remains in the stool, this can indicate impaired fat digestion (PubMed 38429963); reduced enzyme production by the pancreas can show up as fatty stools, bloating and weight loss (PubMed 37737818).

pH reflects the environment in the large intestine: when bacteria ferment fibre, it falls (PubMed 11427691). A very acidic value can indicate a lot of undigested carbohydrate. If a child is not thriving or has fatty stools, that is a matter for a paediatrician.

A newborn's gut is colonised in the first days of life. Mode of birth, breast or bottle feeding, complementary food and antibiotics shape which bacteria settle. In infants, bifidobacteria usually dominate; in the first years of life the gut flora becomes more diverse (PubMed 29118049).

In studies, features of the early gut flora have been associated with later conditions such as asthma or allergies (PubMed 29118049, PubMed 37138015). These are observations in groups; nothing can be predicted from them for an individual child.

Recurrent abdominal pain is common in children. Often no other disease is found after a medical examination; this is then called functional abdominal pain. According to the Rome IV criteria, the diagnosis can be made based on the complaints without every test being necessary (PubMed 27144632).

Experts emphasise avoiding unnecessary burdensome tests in children (PubMed 33154368). A stool test therefore cannot replace a paediatric examination and is not a way to investigate abdominal pain.

The gut check-up is intended for children and teenagers. For younger children, the parents collect the sample; older children and teenagers can do it themselves. For children under 3, please check with the ORY team beforehand, because the gut flora and some values such as calprotectin change considerably in the first years of life (PubMed 40525108).

In children, research associates the gut flora and gut markers with the following complaints and conditions, with varying strength of evidence:

• Recurrent abdominal pain without an apparent cause (functional abdominal pain, including irritable bowel syndrome in children): common, affecting 3–16% of children depending on country and age; factors discussed include gut flora, gut sensitivity and infections (PubMed 33154368).
• Chronic inflammatory bowel diseases such as Crohn's disease: elevated calprotectin in stool, well documented; in young children, however, values are naturally higher (PubMed 31088326, PubMed 40525108).
• Coeliac disease: associated with a more permeable gut wall, well documented (PubMed 31076401). The diagnosis is made by blood tests and, if necessary, a tissue sample, not from stool.
• Protein loss via the gut with fluid retention: rare; in stool it shows up as elevated alpha-1 antitrypsin (PubMed 20571826).
• Atopic dermatitis and allergies: links between early gut flora and the development of the immune system are being researched (PubMed 37138015).
• Histamine intolerance with abdominal pain, diarrhoea, headache or flushing after histamine-rich meals: described, mainly in adults (PubMed 17490952).

These are associations from studies, not causes in an individual child. A stool test cannot explain complaints and does not provide a diagnosis. Your child's persistent complaints should first be seen by a paediatrician.

Take your child to a paediatrician first if warning signs occur. According to the Rome IV criteria for children, these include (PubMed 27144632): unintended weight loss or a drop in the growth curve, blood in the stool, diarrhoea or pain that wakes the child at night, persistent vomiting, difficulty swallowing, unexplained fever, joint complaints, pain clearly away from the navel, delayed puberty, and chronic inflammatory bowel disease or coeliac disease in the family.

In babies and toddlers with diarrhoea or vomiting, signs of dehydration are an emergency: hardly any wet nappies, a dry mouth, unusual drowsiness. If you suspect coeliac disease, let your child keep eating gluten until the work-up, otherwise the tests may come back falsely normal.

This page does not give treatment recommendations, including on diet or supplements. Whether a result means anything for your child and which steps make sense depends on age, complaints, growth and previous findings.

That belongs in a conversation with your paediatrician or with the ORY expert team or with your doctor or naturopath, for example from the ORY expert network. The results consultation with you as a parent is included in the price.

No antibiotics for 4 weeks beforehand and no probiotic supplements for 1 week beforehand (yoghurt and kefir are allowed), no major change in diet for 3 days beforehand. Never stop your child's prescribed medication without talking to the paediatrician. Postpone sampling if your child has an acute stomach bug or fever.

Ideally collect the sample in the morning, using the collection aid or, for young children, directly from a clean potty. It must not come into contact with urine or water. Keep it cool until shipping (do not freeze) and send it from Monday to Thursday.

Analysis usually takes 7–21 days from the arrival of the sample at the laboratory. Afterwards we offer you a free 10-minute discussion of the results. As soon as your report is ready, we let you know. A results consultation with the ORY expert team is included in the price.

The gut check-up for children and teenagers costs €315 including VAT, shipping, return postage and results consultation.

Statutory health insurance in Germany generally does not cover stool analyses you order yourself. With private insurance, reimbursement may be possible; how it works is described under "Reimbursement by private insurance".

The gut check-up for children and teenagers (€315) is designed for sample collection with a parent. For adults, similar areas are covered by the basic gut profile (€285) and the gut profile microbiome & gut barrier (€315). For histamine alone there is the histamine stool test (€55).

Whether a test makes sense for your child at all can be clarified in the free initial consultation and with your paediatrician.