My child might be having a flare: What should I do?

Your child has IBD and their symptoms have suddenly changed. Could it be a flare? Here’s what parents should know about recognising a possible IBD flare, what to do next and when to contact your child’s healthcare team.

One of the biggest worries after your child is diagnosed with Crohn’s disease or ulcerative colitis is knowing what to do when they suddenly become unwell.

Maybe they’re going to the toilet more often.

Perhaps you’ve noticed blood or mucus in their stool.

They might be complaining about tummy pain, feeling unusually tired or losing their appetite.

And you’re wondering:

“Is this an IBD flare?”

You don’t need to work that out on your own.

The most important thing is to recognise changes, know your child’s usual symptoms and contact their IBD team when you’re concerned.

🔥 What is an IBD flare?

An IBD flare is a period when the disease becomes more active and there is increased inflammation in the digestive tract.

A flare can look different from one child to another.

Some children have obvious symptoms, while others may have changes that are more subtle.

Symptoms can include:

• More frequent bowel movements

• Diarrhoea

• Blood in the stool

• Mucus in the stool

• Abdominal pain or cramping

• Increased urgency

• Accidents or difficulty getting to the toilet in time

• Reduced appetite

• Fatigue

• Weight loss

• Fever

• Waking during the night to use the toilet

Your child’s symptoms may not be exactly the same each time.

🧐 First: look for a change from your child’s normal

You know your child best.

If they are usually having two bowel movements a day and suddenly they’re having six, that’s important information.

If they normally have plenty of energy but suddenly they’re exhausted, that’s worth paying attention to.

If they’ve been in remission and new symptoms have appeared, tell their IBD team.

You don’t need to wait until symptoms become severe before asking for advice.

💩 Keep track of bowel movements

If you think your child may be having a flare, it can help to keep a simple record.

Write down:

How often?

How many bowel movements are they having?

What does it look like?

Is it formed, loose or watery?

Is there blood?

Note whether you see blood and how much.

Is there mucus?

Note whether you see mucus and whether it is new or happening more often than usual.

Is there urgency?

Are they suddenly struggling to get to the toilet in time?

Are they waking overnight?

You don’t need to become obsessed with tracking every bowel movement.

A simple record for a few days can give your healthcare team useful information.

🩸 What if there is blood?

Blood in the stool can occur with ulcerative colitis and Crohn’s disease, particularly when the bowel is inflamed.

If your child has IBD and you notice new or increasing blood in their stool, contact their healthcare team for advice.

Tell them:

• When you first noticed it

• How often it is happening

• Whether it is getting worse

• Whether your child has other symptoms

• Whether they are having more bowel movements than usual

Blood in the stool doesn’t always mean your child is having an IBD flare. Infections and other problems can also cause bleeding.

Your child’s healthcare team can help determine what needs to happen next.

🤢 Could it be a stomach bug instead?

This is one of the hardest things for parents to work out.

Diarrhoea, abdominal pain, nausea and fever can happen with infections as well as IBD flares.

This is why your child’s doctor may recommend stool testing when symptoms suddenly change.

Don’t assume every episode of diarrhoea is an IBD flare — and don’t assume it is a stomach bug either.

Contact your child’s healthcare team if you’re unsure.

📞 Contact your IBD team

If your child’s symptoms are changing, your IBD team is the best place to get advice about what to do next.

They may want to know about:

• Bowel movement frequency

• Blood or mucus

• Abdominal pain

• Appetite

• Energy

• Weight

• Fever

• Medication

• Recent infections

• How long symptoms have been happening

Depending on the situation, they may recommend monitoring your child, arranging blood or stool tests, reviewing their medication or seeing them in clinic.

💊 Don’t change medication on your own

If you think your child is having a flare, you may be tempted to increase their medication or restart an old medication that worked previously.

Don’t make medication changes without speaking with your child’s healthcare team.

Your child’s treatment plan may depend on what is causing their symptoms and how active the inflammation is.

Some medications also need to be changed carefully rather than suddenly stopped or restarted.

If you have been given a specific flare plan by your child’s IBD team, follow that plan and contact them if you are unsure what to do.

💧 Keep an eye on hydration

Diarrhoea and frequent bowel movements can cause children to lose fluids.

Encourage your child to drink regularly.

Watch for signs that they may be becoming dehydrated, such as:

• Very dark urine

• Passing urine much less often

• Dry mouth

• Dizziness

• Unusual sleepiness

• Weakness

• Being unable to keep fluids down

If you’re concerned that your child may be dehydrated, seek medical advice promptly.

🍽️ What should my child eat during a possible flare?

There isn’t one food or diet that is right for every child with IBD.

When your child is unwell, the priority is generally making sure they can drink and maintain adequate nutrition, while following any advice your child’s healthcare team has already given you.

Your child may temporarily tolerate some foods better than others.

Try not to introduce a highly restrictive diet without guidance from your child’s gastroenterologist or IBD dietitian.

If your child is eating very little, losing weight or struggling to maintain nutrition, contact their healthcare team.

😴 What about fatigue?

Fatigue can be an important symptom of active IBD.

Your child may:

• Sleep more than usual

• Struggle to get through the school day

• Have difficulty concentrating

• Stop wanting to play

• Need more rest after normal activities

Fatigue can have many causes, including active inflammation and anaemia.

If your child’s energy levels have changed significantly, tell their healthcare team.

📚 What about school?

If your child is having increased symptoms, they may need some flexibility at school.

You may need to arrange:

• Easy access to a toilet

• Extra bathroom breaks

• Rest breaks

• Reduced workload temporarily

• Help catching up after absences

• Flexibility around appointments

You don’t have to wait until your child has missed a lot of school before talking to their teacher or school support team.

Your child’s needs may change depending on how they’re feeling.

🚨 When should I seek urgent medical help?

Your child’s IBD team should give you specific instructions about when to seek urgent care.

In general, seek urgent medical attention if your child is very unwell or deteriorating, particularly if they have symptoms such as:

• Severe or worsening abdominal pain

• Significant or persistent bleeding

• Repeated vomiting

• Severe dehydration

• Fainting or significant dizziness

• A very high or persistent fever

• A swollen or unusually distended abdomen

• Severe weakness or unusual drowsiness

• Inability to keep fluids down

• Rapid deterioration

If you are seriously concerned about your child’s condition, seek urgent medical care rather than waiting for the next appointment.

🧪 Your child’s doctor may order tests

If a flare is suspected, your child’s healthcare team may recommend tests to work out what is happening.

These may include:

Blood tests

Blood tests can look for signs of inflammation, anaemia, dehydration and other changes.

Stool tests

A stool sample may be used to check for infection and measure faecal calprotectin, which can provide information about intestinal inflammation.

Other investigations

Depending on your child’s symptoms and medical history, the team may recommend additional tests, imaging or an appointment.

Not every suspected flare requires every test.

📊 How will we know if it really is a flare?

Your child’s healthcare team may look at several pieces of information.

This can include:

Symptoms

What has changed?

Blood tests

Are there signs of inflammation or anaemia?

Stool tests

What does the faecal calprotectin show? Is there evidence of infection?

Growth and weight

Has your child been gaining weight and growing as expected?

Examination

What does your child’s physical examination show?

Previous results

How does this compare with your child’s previous symptoms and test results?

There isn’t always one test that gives a simple yes-or-no answer.

📝 Make a simple flare plan with your child’s team

If your child has had IBD for a while, ask their gastroenterologist:

“Can we make a plan for what to do if we think my child is having a flare?”

Write down:

☐ What symptoms should make us call?

☐ Who should we contact?

☐ What number should we use during clinic hours?

☐ Who do we contact outside clinic hours?

☐ What tests might be needed?

☐ What should we do about medication?

☐ When should we go to hospital?

Having these answers written down can make a stressful situation much easier to manage.

💛 What if you’re not sure?

You don’t have to be certain that your child is having a flare before contacting their IBD team.

If something has changed and you’re worried, it’s okay to ask.

You might simply say:

“My child has IBD and this isn’t their usual pattern. Could you tell me what we should do?”

That’s enough.

Your child’s healthcare team would rather know about a change in symptoms than have you sit at home worrying about whether you’re overreacting.

❤️ Remember: you know your child’s normal

You will gradually become familiar with your child’s own IBD pattern.

You’ll learn what their normal bowel habits look like, how much energy they usually have and what symptoms tend to happen when they’re unwell.

But you don’t have to become an expert at diagnosing flares.

Your role is to notice changes, keep your child’s healthcare team informed and follow the plan you’ve been given.

If your child has IBD and you think something isn’t right, don’t wait until you have all the answers.

Notice the change. Write it down. Contact the team.