Inflammatory bowel disease (IBD) is a lifelong condition that causes inflammation in the gastrointestinal tract (GI). While often diagnosed in adolescents and young adults, more young children are now developing IBD.

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IBD is a common condition, affecting around 1.6 million Americans. It can occur at any age, but 25% of all cases are children and adolescents before 20 years old. Among children with IBD, 4% present before 5 years, 18% before 10 years, and the peak occurs in adolescence.

Early detection is essential to prevent complications such as malnutrition or growth delays.

This article explores IBD in children, looks at the symptoms and discusses the causes and possible complications associated with IBD in children.

IBD has two main types, Crohn’s disease and ulcerative colitis (UC). IBD symptoms may vary depending on the kind of disease and location of the inflammation.

Symptoms also differ from child to child, similar to symptoms an adult may experience. Common symptoms include:

However, around 22% of children may present with atypical symptoms initially, including:

Learn more about IBD from our dedicated content hub.

Pediatric-onset IBD may be more severe and has increased disease activity than adult-onset IBD.

Children with IBD may experience malabsorption or the inability to absorb nutrients from food. A 2022 study showed that children with Crohn’s are vulnerable to malnutrition.

The following factors increase a child’s risk of developing malnutrition:

Children with IBD may not grow as well as others and go through puberty later. According to a 2015 study, growth failure occurs in 40% of people with Crohn’s and 10% of those with UC. About 19% of children with Crohn’s will grow 8 centimeters shorter than expected as adults.

A 2020 study also found that adults with child-onset IBD have slightly reduced height than their peers, especially those with a more severe disease course and pre-pubertal onset.

A 2017 study also found that children with IBD are at an increased risk of gastrointestinal infections than the general population.

The exact cause of IBD is not clear. However, a combination of the following factors can affect a child’s immune system and cause an abnormal inflammatory reaction in the intestinal wall:

  • genetic
  • environmental
  • microbial

IBD also tends to run in families. A family history of UC and Crohn’s is present in up to 28% of children.

Close family members of a person with IBD have a 1 in 3 chance of developing IBD. Moreover, genetic factors may also play an essential role in early onset-pediatric IBD than adult-onset IBD. There are more than 200 genes associated with early-onset pediatric IBD.

However, not all people with IBD have a family history of the condition. Other contributing factors may cause IBD to develop.

A doctor will conduct a thorough health history and physical examination and use a combination of tests to diagnose IBD. Testing may include:

  • Blood tests: This looks for conditions such as anemia and signs of inflammation in the body.
  • Stool studies: These check for blood in the stool, infection, and signs of inflammation in the child’s intestines.
  • Imaging tests: These include CT scans and MRI scans to look for inflammation, swelling, blockages, and narrowing in the intestines.
  • Barium swallow: This test requires a child to swallow a barium fluid to coat the inside of the organs in the upper GI tract.
  • Barium enema: This test coats the large intestines, including the colon and rectum, to examine narrowed areas called strictures.
  • Upper endoscopy or colonoscopy: This procedure uses a small flexible tube with a tiny camera called an endoscope to see inside the tract. A doctor can take a biopsy or tissue sample for testing.
  • Capsule endoscopy: This procedure involves the child swallowing a special capsule, and a camera takes photos of the small intestine.

The treatment program will depend on the location and severity of the child’s condition and whether they have UC or Crohn’s.

Treatment goals for IBD in children include:

  • eliminating symptoms and restoring quality of life
  • correcting nutritional deficiencies to restore average growth
  • preventing future flare-ups and inducing remission
  • healing the intestines
  • eliminating or preventing complications

Doctors may recommend a range of nonsurgical and surgical treatments for a child, including:

Medications

A doctor may give a child different medications depending on their symptoms. These include medicines for pain, inflammation, diarrhea, and vomiting. They may also get drugs to prevent infection and stop their immune system from attacking their bodies.

Read more about specific medications for UC.

Nutrition and supplements

Many children with IBD do not absorb enough nutrients, which may lead to vitamin deficiencies. Doctors may perform tests to assess their nutrient levels and recommend specific vitamins and minerals or special shakes or drinks to meet their nutritional needs.

Read more about supplements specifically for Crohn’s.

Exclusive enteral nutrition

Intestinal inflammation makes it difficult for a child’s body to absorb the nutrients needed to help them grow. Doctors may therefore give children 100% of their nutritional needs in a liquid formula through a nasogastric tube to feed them. Children usually receive this treatment for 6–12 weeks to give the GI tract enough time to heal.

Learn more about the enteral diet.

Diet

Certain foods can also trigger or worsen IBD. Children may use a particular meal plan or avoid certain foods that may cause a flare.

Learn more about foods to eat and avoid with UC.

Surgery

A child may need surgery if they develop complications, including:

A doctor can also recommend specific surgery for UC and surgical procedures for Crohn’s.

IBD symptoms may come and go. A child can go months to years without any symptoms, called remission. However, symptoms can also reappear, called a flare.

Below are things that can help manage flares:

  • Keep the child hydrated: Hydration is a common issue in children with IBD, especially those with diarrhea. A child should drink water and electrolyte drinks to hydrate, but avoid sugary drinks as they may worsen symptoms. Read more about the benefits of drinking enough water.
  • Balanced nutrition: Easy-to-digest food can reduce the irritation of the digestive tract during a flare. Learn more about the low fiber diet.
  • Prevent skin irritation and ulcers: Frequent diarrhea may irritate the anal area. Keeping the anal area clean and dry is essential to prevent ulcerations and irritation. A person may also apply a zinc-oxide treatment to protect intact skin.
  • Consult with a pediatrician: It is essential to alert the doctor at the first sign of symptoms. Doctors can provide new medications or treatments and run tests to help determine the flare cause.
  • Avoid nonsteroidal anti-inflammatory drugs (NSAIDs): Doctors will not prescribe NSAIDs for pain as they may worsen a flare but will provide pain relievers suitable for children.

IBD can occur at any age, but 1 in 4 cases occurs before a person is 20 years old. While children may experience similar symptoms to adults, a child with IBD is at an increased risk of developing certain other medical conditions, such as arthritis or malnutrition. Adults with childhood-onset IBD may also have slightly reduced heights compared to their peers.

While there is no cure for IBD, pediatricians can help manage symptoms with suitable medical treatments and lifestyle changes.