Could my child have IBD? Symptoms, tests and what parents need to know

When your child has ongoing stomach pain, diarrhoea or other unexplained symptoms, it is natural to wonder whether something more than an ordinary tummy bug could be happening.

Inflammatory bowel disease (IBD) is a chronic condition that causes inflammation in the digestive tract. It includes Crohn's disease and ulcerative colitis, and both can affect children as well as adults.

Recognising the possible signs of IBD in children is important because early assessment can help identify the cause of symptoms and ensure children receive appropriate care. However, many childhood digestive symptoms have causes other than IBD, so having symptoms does not automatically mean your child has the condition.

If you are worried about your child, this guide explains the symptoms to look out for, when to seek medical advice, which tests may be used and how to support your child while waiting for answers.

🔎 What is IBD?

Inflammatory bowel disease is the name for a group of conditions that cause ongoing inflammation in the digestive tract.

The two main types of IBD in children are:

• Crohn's disease: Can affect any part of the digestive tract, from the mouth to the anus. Inflammation may affect different layers of the bowel wall.

• Ulcerative colitis: Causes inflammation in the lining of the large intestine, including the colon and rectum.

Both conditions can cause abdominal pain, diarrhoea, fatigue and other symptoms. However, the location and severity of inflammation vary between children.

IBD is different from irritable bowel syndrome (IBS). IBS can cause abdominal pain and changes in bowel habits, but it does not cause the same type of intestinal inflammation as IBD.

IBD is also not caused by poor parenting, something your child ate or stress alone. Although the exact causes are not fully understood, genetic, environmental and immune system factors are thought to contribute.

There is currently no universal cure for IBD, but treatment can help control inflammation, manage symptoms and support healthy growth and development.

🚩 Signs and symptoms of IBD in children

IBD can look different from one child to another. Some children develop obvious digestive symptoms, while others initially show less specific signs, such as fatigue, anaemia or difficulties with growth.

Symptoms may develop gradually or become more noticeable over time.

Possible signs of IBD include:

• Persistent diarrhoea: Loose or watery stools that continue or keep returning.

• Blood in the stool: Blood may appear on the toilet paper, in the toilet bowl or mixed with the stool.

• Mucus in the stool: Mucus may occur alongside other digestive symptoms.

• Recurring abdominal pain: Pain or cramping that does not settle or repeatedly returns.

• Urgency: Feeling an urgent need to use the toilet, sometimes with difficulty holding on.

• Frequent bowel movements: Needing to pass stool more often than usual.

• Fatigue: Feeling unusually tired, weak or lacking energy.

• Reduced appetite: Eating less than usual or losing interest in food.

• Unexplained weight loss: Losing weight without trying.

• Poor growth or delayed puberty: Growing more slowly than expected or developing later than peers.

• Anaemia or iron deficiency: Sometimes causing paleness, tiredness, weakness or dizziness.

• Symptoms outside the digestive tract: Such as joint pain, mouth ulcers, skin changes or eye inflammation.

Not every child with IBD will have all these symptoms. Some children may have only a few, and the symptoms can overlap with other conditions.

📏 Can IBD affect growth before digestive symptoms appear?

Yes. In some children, poor growth, weight loss or delayed puberty may be noticeable before the cause of their symptoms becomes clear.

Ongoing intestinal inflammation can affect appetite, nutrient absorption and the body's nutritional needs. Inflammation itself can also interfere with normal growth and development.

Parents might notice that their child is not gaining weight as expected, has dropped down their usual growth chart or seems smaller than other children of a similar age.

These signs do not automatically indicate IBD, but they deserve medical assessment, especially when they occur alongside abdominal pain, diarrhoea, fatigue or unexplained iron deficiency.

If you are concerned about your child's growth, ask your GP to review their height and weight measurements over time rather than relying on a single measurement.

🩺 When should I take my child to the doctor?

You do not need to wait until symptoms become severe before making an appointment.

Arrange a GP appointment if your child has:

• Diarrhoea that persists or repeatedly returns.

• Blood in their stool.

• Recurrent abdominal pain that does not settle.

• Unexplained weight loss or poor growth.

• Persistent fatigue or diagnosed iron deficiency without a clear explanation.

• Ongoing changes in bowel habits alongside other concerning symptoms.

• Digestive symptoms combined with a family history of IBD.

Tell the doctor how long the symptoms have been happening, how frequently they occur and whether they are affecting your child's sleep, appetite, school attendance or usual activities.

It is also important to mention symptoms such as mouth ulcers, joint pain, skin changes or problems around the anus, including persistent pain, swelling or drainage.

Seek urgent medical assessment if your child has severe or worsening abdominal pain, significant abdominal swelling, persistent vomiting, heavy rectal bleeding, signs of dehydration or appears seriously unwell. If your child needs emergency care, do not wait for a routine GP appointment.

If your child needs emergency care, contact your local emergency services number immediately.

The urgency of an assessment depends on your child's symptoms and overall condition. Your GP can help determine whether further investigation or referral to a paediatric gastroenterologist is needed.

🧩 Could it be something other than IBD?

Yes. Many conditions can cause symptoms similar to those of IBD, and some are much more common in children.

Possible explanations include:

• Gastroenteritis: An infection that may cause diarrhoea, abdominal pain, vomiting and sometimes fever.

• Constipation: Can cause abdominal pain, bloating and changes in bowel movements. Occasionally, loose stool may pass around impacted stool.

• Irritable bowel syndrome (IBS): Can cause recurring abdominal pain, diarrhoea, constipation or alternating bowel habits without the intestinal inflammation characteristic of IBD.

• Coeliac disease: An immune-mediated condition triggered by gluten that can cause digestive symptoms, fatigue, iron deficiency and poor growth.

• Food intolerances: Certain foods or ingredients may trigger symptoms in some children.

• Other infections: Some bacterial or parasitic infections can cause prolonged diarrhoea or abdominal pain.

• Other digestive conditions: Depending on the symptoms, doctors may consider additional causes of inflammation, bleeding or poor nutrient absorption.

Symptoms alone cannot reliably distinguish IBD from these conditions.

For example, blood in the stool should not automatically be attributed to IBD, but it should not be dismissed either. Similarly, abdominal pain can occur with IBS, constipation and many other conditions.

Your child's doctor will use their history, examination and appropriate tests to help determine what is causing the symptoms.

🧪 What tests can help diagnose IBD?

There is no single blood test or symptom that confirms every case of IBD. Diagnosis usually involves combining information from your child's medical history, physical examination, blood and stool tests, and sometimes endoscopy and imaging.

Your child may not need every test listed below. The medical team will decide which investigations are appropriate.

🩸 Blood tests

Blood tests can help doctors look for signs of inflammation, anaemia and nutritional problems.

They may include:

• Full blood count: Checks for anaemia and other changes in blood cells.

• C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): Markers that can indicate inflammation.

• Iron studies: Help identify iron deficiency.

• Albumin and other blood chemistry tests: Help assess nutritional status and general health.

• Additional tests: Such as liver function, vitamin levels or tests for other conditions, depending on your child's symptoms.

Blood tests can provide useful clues, but normal results do not completely rule out IBD. Some children with active disease have few or no abnormalities in their blood tests.

💩 Stool tests

Your doctor may request stool samples to investigate infection and look for evidence of intestinal inflammation.

Two important types of stool testing are:

• Stool infection testing: Checks for bacteria, parasites or other infections that may cause similar symptoms.

• Faecal calprotectin: Measures a protein associated with inflammation in the intestines. An elevated result can indicate intestinal inflammation and help doctors decide whether further investigation is needed.

Faecal calprotectin is not a specific test for IBD. Infections and other conditions can also raise the level, and results need to be interpreted alongside your child's symptoms and other findings.

Age matters when interpreting results, particularly in younger children. A single result cannot establish the diagnosis on its own.

🔬 Endoscopy and colonoscopy

If IBD is suspected, a paediatric gastroenterologist may recommend endoscopy.

A colonoscopy allows the doctor to examine the lining of the colon and usually the end of the small intestine. Small tissue samples, called biopsies, can be taken for examination under a microscope.

An upper gastrointestinal endoscopy allows the doctor to examine the upper digestive tract. It may be performed as part of the assessment, particularly when Crohn's disease is suspected.

These procedures are generally performed with appropriate sedation or anaesthesia in children. The team will explain the preparation, what happens during the procedure and how your child will be cared for afterwards.

Endoscopy and biopsies can provide important information about the presence, location and type of inflammation.

🖥️ Scans and other investigations

Some children need additional imaging to examine areas of the digestive tract that cannot be fully assessed by endoscopy.

Depending on the situation, this may include:

• MRI of the small bowel, sometimes called MR enterography.

• Ultrasound.

• Other imaging or specialised investigations recommended by the gastroenterology team.

The choice depends on your child's symptoms, test results and the suspected location of the disease.

⏳ How long does it take to get an IBD diagnosis?

The time needed to reach a diagnosis varies between children.

Some children have clear symptoms and test results that lead to relatively straightforward investigations. Others need several tests because their symptoms overlap with those of other conditions.

Blood and stool tests may be completed before a specialist appointment. If endoscopy, biopsies or imaging are needed, arranging and completing these investigations can take additional time.

Waiting for answers can be particularly difficult when your child is uncomfortable and you are worried about what might be causing their symptoms.

If your child's symptoms worsen while you are waiting, contact your GP or the service managing the referral. Do not assume that you must wait for the scheduled appointment if your child's condition has changed.

Ask who you should contact if symptoms progress, whether there is a cancellation list and whether the referral needs to be updated based on new symptoms or test results.

💚 What happens if my child is diagnosed with IBD?

If your child is diagnosed with Crohn's disease or ulcerative colitis, their gastroenterology team will explain the diagnosis and develop a treatment plan suited to their needs.

The plan will depend on the type of IBD, the location and severity of inflammation, your child's symptoms and their growth and nutritional status.

Treatment may involve:

• Medication to reduce inflammation and help achieve remission.

• Nutritional support, sometimes including specialised nutritional treatments.

• Regular blood and stool tests to monitor disease activity.

• Monitoring height, weight and puberty.

• Support with school, friendships and emotional wellbeing.

• Further investigations when needed to assess how well treatment is working.

Treatment can look different for every child. Some children respond well to their initial treatment, while others need additional therapies to control inflammation.

You will also learn about flares and remission. A flare is a period of increased disease activity, while remission means the disease is controlled. Even when symptoms improve, ongoing monitoring may be needed to check that inflammation has settled.

Although IBD is a chronic condition, effective treatment can help many children feel better, participate in everyday activities and enjoy long periods with few symptoms.

🫶 How to support your child while waiting for answers

Waiting for test results or a specialist appointment can be one of the hardest parts of the process. You may be worried about your child's symptoms while trying to reassure them that everything will be okay.

You do not need to have all the answers. Your child needs to know that you are listening, taking their symptoms seriously and helping them get the care they need.

Keep a record of symptoms

A simple diary can help you remember details when speaking to your doctor. You might record:

• How often your child has bowel movements.

• Whether there is blood or mucus in their stool.

• When abdominal pain occurs and how severe it seems.

• Changes in appetite, energy or weight.

• Any symptoms that wake them during the night.

• Missed school days or activities.

• Any new symptoms or changes in their condition.

You do not need to track everything obsessively. Focus on information that helps you describe what is happening.

Keep everyday life as normal as possible

Where your child feels well enough, encourage them to continue enjoying their usual activities, friendships and interests. Allow extra rest when they need it, and avoid making every conversation about their symptoms.

Explain things honestly

If your child asks whether they have IBD, you can explain that the doctors are investigating what is causing their symptoms and that the tests will help them understand what is happening.

Avoid promising that everything will be fine or suggesting that the symptoms are nothing to worry about. Reassure them that you are taking their concerns seriously and will work through the next steps together.

Do not make major dietary changes without advice

Try to maintain a balanced diet that your child tolerates comfortably. Avoid restrictive diets or supplements intended to treat suspected IBD unless these have been discussed with an appropriate healthcare professional.

Ask for help when you need it

If symptoms worsen, contact your child's doctor rather than waiting for the next scheduled appointment. If your child develops emergency warning signs, seek urgent medical care.

📝 Questions to ask your child's doctor

Medical appointments can feel overwhelming, particularly when you are worried about your child.

Writing down your questions beforehand can help you get the information you need.

Consider asking:

• Could my child's symptoms be consistent with IBD?

• What other conditions might explain their symptoms?

• Which blood and stool tests should we arrange?

• Does my child need a faecal calprotectin test?

• Should we see a paediatric gastroenterologist?

• What should we do if symptoms worsen while we wait?

• Are there any symptoms that mean we should seek urgent care?

• Should we monitor their weight, height or appetite?

• Is there anything we should avoid changing before the investigations are complete?

• Who should we contact if we have concerns after the appointment?

You do not need to ask every question at once. Start with the ones most relevant to your child's current symptoms.

🌿 Helpful resources and next steps

Reliable information can help you understand IBD and prepare for conversations with your child's doctor. Try to prioritise reputable medical organisations and paediatric healthcare services rather than relying on social media posts or individual stories.

Here are some useful starting points for families around the world.

• Royal Children's Hospital Melbourne – Inflammatory bowel disease: Information about symptoms, diagnosis and treatment in children.

• Sydney Children's Hospitals Network – IBD diagnosis: An explanation of the investigations used to diagnose IBD.

• Crohn's & Colitis Australia: Information and support for Australian families.

• Crohn's & Colitis Foundation: Educational resources and support in the United States.

• Crohn's & Colitis UK: Information about IBD and accessing support in the United Kingdom.

• Crohn's and Colitis Canada: Resources for people and families affected by IBD in Canada.

• Crohn's & Colitis New Zealand: Information and support for families in New Zealand.

These resources can help you understand the condition, but they cannot determine whether your child has IBD. That requires an individual medical assessment.

🌷 Remember, you're doing the right thing by asking questions

When your child has unexplained digestive symptoms, it is natural to worry about what might be causing them.

You do not need to assume the worst, but you also do not need to dismiss persistent symptoms or wait until they become severe before seeking medical advice.

Keep track of what you have noticed, arrange an appointment with your child's doctor and ask for further investigation if symptoms persist or there are concerning signs.

If your child is diagnosed with IBD, you will have a healthcare team to help you understand the condition and decide on appropriate treatment. If the cause turns out to be something else, getting answers can still help your child receive the right care.

You do not have to work out the diagnosis yourself. Your job is to notice when something is wrong, seek help and support your child while you find the answers together.