Children with inflammatory bowel disease

During active flares, the priorities shift. Maintaining adequate intake when a child feels unwell, nauseous, or in pain is challenging. Dietary priorities shift — it's a time for pragmatism, and the specific approach depends on the child's symptoms and disease activity. This is exactly the kind of thing a consultation covers.

Some children lose weight rapidly during flares, and catching up afterward is important. I work out calorie and protein targets for recovery, plan for catch-up growth, and make sure micronutrient gaps (iron, vitamin D, zinc, and B12 are common in IBD) are addressed. The nutritional plan should adapt to where the child is in their disease course - flare, recovery, and remission all need different approaches.

Partial enteral nutrition (using nutritional drinks alongside food) can also play a role in maintaining remission after EEN. The evidence is growing for this approach, and it's something I discuss with families as part of the longer-term plan.

One of the most common questions I get from families is 'what foods should my child avoid?' The honest answer is: it depends. IBD isn't caused by diet, and blanket food restrictions aren't helpful. But individual trigger foods can worsen symptoms in some children, and working out which foods are genuine triggers (and which aren't) is something a structured dietetic approach can help with.

Low-FODMAP diets are sometimes trialled for children with IBD who have ongoing gut symptoms despite controlled disease. FODMAPs are fermentable carbohydrates that can cause bloating, gas and discomfort in some people. The diet is a diagnostic tool, not a permanent way of eating - it's a structured process that should only be done with specialist dietetic guidance.

Growth failure is one of the hallmarks of paediatric IBD, particularly Crohn's disease, as highlighted by Crohn's & Colitis UK. Up to 40% of children with Crohn's have impaired growth at diagnosis. Catching up is a major goal of treatment, and nutrition is central to that. The window for catch-up narrows as puberty progresses, which is why early, active nutritional management matters so much.

Bone health is another long-term concern. Chronic inflammation, poor absorption, steroid use, and low vitamin D all affect bone density. I routinely assess calcium and vitamin D status and supplement where needed. These are things that matter now but also twenty years from now.

The good news, as the BSPGHAN highlights, is that with proper treatment - including proper nutritional management - most children with IBD do well. Growth catches up, puberty progresses normally, and the long-term outlook has improved significantly with modern treatment approaches. My role is making sure the nutrition piece is fully optimised alongside medical management.