IBD and puberty

Is your child going through puberty later than their friends, or are you wondering whether IBD could affect their development?

Puberty is a time of major physical, emotional and social change. For children with Crohn’s disease or ulcerative colitis, puberty can sometimes happen later than expected, particularly when IBD has been active or difficult to control.

This can understandably be worrying for both children and parents. The good news is that delayed puberty does not necessarily mean something is permanently wrong. With appropriate IBD treatment, nutrition and monitoring, many children continue through puberty and reach their expected growth and development.

🌱 Can IBD affect puberty?

It can.

Active IBD may affect puberty in several ways. Ongoing inflammation can increase the body’s nutritional and energy needs, while symptoms such as abdominal pain, diarrhoea and poor appetite can make it difficult for a child to eat enough.

When the body is dealing with ongoing inflammation or isn’t getting enough energy and nutrients, growth and puberty can sometimes slow down.

This is more commonly associated with Crohn’s disease, but children with ulcerative colitis can also experience growth or pubertal difficulties.

Your child’s IBD team will consider their individual growth pattern, nutritional status, inflammation and stage of puberty rather than looking at one measurement alone.

📏 What is delayed puberty?

Children enter puberty at different ages, so there is a wide range of normal development. Doctors may consider puberty to be delayed when the expected physical changes have not started by a particular age. The age at which this becomes a concern differs between boys and girls.

It’s also important to remember that being later than friends does not automatically mean puberty is medically delayed.

Some children simply mature later than others, particularly if there is a family history of later puberty.

Your child’s doctor can assess whether their development is within the expected range.

👀 What signs of puberty should parents look for?

Puberty looks different for every child and doesn’t happen in exactly the same order or at the same speed.

Depending on your child’s age and sex, changes can include:

• growth in height

• changes in body shape

• breast development in girls

• testicular and penile development in boys

• growth of pubic and underarm hair

• changes in body odour

• acne or changes in skin

• voice changes in boys

• the start of periods in girls.

Your child’s healthcare team may monitor these changes during routine appointments.

📈 What if my child isn’t growing as quickly as their friends?

Children don’t all grow at the same rate.

However, slower growth can sometimes be an important sign of active IBD or inadequate nutrition.

Your child’s IBD team may regularly monitor:

• height

• weight

• growth velocity — how quickly your child is growing

• BMI, when appropriate

• pubertal development.

They will usually plot measurements over time to look for changes in your child’s individual growth pattern.

A child who has always been smaller than their peers but continues to grow steadily may not have the same concerns as a child whose growth has recently slowed or stopped.

🥗 Why is nutrition important during puberty?

Puberty is a period of rapid growth, so children need enough energy, protein, vitamins and minerals to support their developing bodies.

Children with IBD may have increased nutritional needs, particularly when inflammation is active.

Nutrients that may be important to monitor include:

• iron

• vitamin D

• calcium

• vitamin B12

• folate

• zinc

• protein and overall energy intake.

Your child’s IBD team or paediatric IBD dietitian can help determine whether your child is getting what they need.

If your child is struggling to eat, losing weight or avoiding food because they are worried about pain or bowel symptoms, let their healthcare team know.

🩸 What about periods?

For girls with IBD, periods may start later if growth and puberty have been affected.

Once periods have started, menstrual cycles can also be irregular during the first few years, which can be normal.

It’s worth talking with your child’s healthcare team if:

• periods have not started when expected

• periods stop after previously being regular

• bleeding is very heavy

• periods are causing significant pain

• your child is losing weight or struggling to eat

• you are concerned about their overall growth or development.

Heavy periods can also contribute to iron deficiency and fatigue, which may be particularly important for a child who already has low iron or anaemia.

💬 What if my teenager feels different from their friends?

This can be one of the hardest parts of delayed growth or puberty.

Teenagers may compare themselves with classmates, siblings or friends and worry that they are “behind”.

They may feel embarrassed, frustrated or different — even when their development is still within a healthy range.

Try to create opportunities for your child to talk about how they feel without making their body or development the focus of every conversation.

You might say:

“Everyone develops at different times. If you’re worried about your body or how you’re growing, we can talk to your doctor together.”

If your child is experiencing significant anxiety, low mood, withdrawal or distress about their body or development, speak with their healthcare team.

💊 Can treating IBD help?

Controlling inflammation is an important part of supporting healthy growth and development.

Your child’s treatment plan may include medication, nutrition support or other treatments designed to control their IBD.

If inflammation is contributing to slowed growth or delayed puberty, getting the disease under good control may allow growth and development to progress.

This is one reason regular monitoring is so important — your child’s healthcare team is looking at more than just whether their tummy symptoms have improved.

🔎 What if puberty still seems delayed?

If your child’s growth or puberty appears slower than expected, their doctor may investigate further.

Depending on your child’s situation, this could include:

• reviewing their growth chart

• assessing their stage of puberty

• checking nutrition and weight

• reviewing IBD symptoms and disease activity

• blood tests

• checking hormone levels

• assessing thyroid function

• considering a bone-age X-ray

• referring to a paediatric endocrinologist.

Not every child will need all of these tests.

The aim is to understand why puberty may be delayed and whether anything needs treatment.

❤️ What can parents do?

You don’t need to monitor every aspect of your child’s development at home.

Keep up with IBD appointments

Regular appointments allow the team to monitor growth, nutrition, inflammation and puberty over time.

Support good nutrition

Offer a varied diet with enough energy and protein to support growth. Avoid unnecessary restrictive diets unless recommended by your child’s healthcare team.

Watch for changes

Let the IBD team know about noticeable changes in:

• appetite

• weight

• height or growth

• energy

• bowel symptoms

• eating patterns

• periods

• puberty or development.

Talk openly about puberty

Make puberty a normal topic of conversation. Your child may have questions they feel uncomfortable asking their parents, so remind them that their IBD team can answer private or sensitive questions too.

Don’t compare

Try not to compare your child’s development with siblings, classmates or friends. Puberty happens at different times for different children.

📞 When should I speak with the IBD team?

Talk with your child’s healthcare team if you are concerned about:

• slowed height growth

• unexplained weight loss

• delayed puberty

• periods that have not started when expected

• periods stopping

• significant fatigue

• poor appetite

• difficulty eating

• ongoing diarrhoea or abdominal pain

• your child’s emotional wellbeing or body image.

Your child’s IBD team can assess the whole picture and decide whether further investigation is needed.

💛 Remember: everyone’s timeline is different

Puberty can be an emotional time for any child. Having IBD can add another layer of worry, particularly if your child’s growth or development seems different from their friends.

Try to remember that puberty doesn’t happen on exactly the same schedule for everyone.

If your child’s growth or development is slower than expected, don’t assume that IBD is the cause — but don’t ignore your concerns either. Their IBD team can monitor growth and puberty and investigate if something doesn’t look right.

With appropriate treatment, nutrition and support, many children with IBD continue to grow and develop normally.

Your child’s body has its own timeline — and they don’t have to navigate it alone.