Nutrition and growth in children with IBD

When a child has Crohn’s disease or ulcerative colitis, nutrition is about much more than what they eat.

Children are growing. They need enough energy, protein, vitamins and minerals not only to feel well today, but also to support healthy growth, puberty, bone health and development.

This is why nutrition and growth are an important part of paediatric IBD care. Children with IBD may be at risk of nutritional deficiencies, poor weight gain or slowed growth, particularly when inflammation is active. Paediatric IBD experts recommend regular nutritional and growth assessment as part of care.

📈 Why is growth so important in children with IBD?

Adults have reached most of their physical growth. Children haven’t.

Active IBD can affect a child’s ability to grow in several ways.

For example:

• inflammation can increase the body’s nutritional demands

• abdominal pain or nausea can reduce appetite

• diarrhoea can make eating difficult

• some children become afraid to eat because they associate food with symptoms

• nutrients may not be absorbed normally in some children

• children may eat less during a flare

• ongoing inflammation can affect normal growth and development.

Growth can therefore provide important information about how your child’s IBD is affecting their overall health.

🧒 What does the IBD team monitor?

Your child’s healthcare team may regularly look at:

• weight

• height or length

• body mass index (BMI), when appropriate

• growth over time

• growth compared with other children of the same age and sex

• puberty and development

• appetite and food intake

• nutritional deficiencies

• disease activity.

The important thing isn’t necessarily whether your child is the biggest or smallest child in their class.

It’s the pattern over time.

Your child’s team may plot their measurements on a growth chart to see whether they are following their expected growth pattern.

⚖️ What if my child is losing weight?

Weight loss can happen during an IBD flare, particularly when a child has diarrhoea, abdominal pain or a poor appetite.

But unexplained or ongoing weight loss should be discussed with your child’s IBD team.

They may want to look at:

• how much your child is eating

• their symptoms

• disease activity

• blood tests

• faecal calprotectin

• nutritional deficiencies

• medication

• growth pattern.

Sometimes the most important step isn’t simply adding more calories. If active inflammation is preventing your child from growing normally, controlling the underlying IBD is also an important part of supporting growth.

📏 What if my child isn’t growing as expected?

Some children with paediatric IBD may have growth delay.

This can sometimes be one of the signs that inflammation has been affecting their body for some time.

Your child’s gastroenterology team may look at their growth over several appointments rather than focusing on one measurement.

They may also consider:

• parental height and expected growth pattern

• puberty stage

• nutritional intake

• disease activity

• inflammation

• medication

• other possible causes of poor growth.

If your child is falling away from their previous growth pattern, ask their IBD team about it.

🍽️ How much should my child eat?

There isn’t one calorie target that is right for every child with IBD.

Nutritional requirements depend on factors such as:

• age

• sex

• height and weight

• activity level

• stage of growth

• puberty

• disease activity

• nutritional status

• individual medical needs.

Children with active IBD may have increased nutritional needs.

Rather than trying to calculate your child’s requirements yourself, ask your IBD team or paediatric dietitian for personalised advice.

🥚 Protein matters

Protein is important for:

• growth

• muscle development

• tissue repair

• maintaining strength

• recovery from illness.

Good sources can include:

• eggs

• fish

• chicken

• meat

• yoghurt

• cheese

• milk or suitable alternatives

• tofu

• beans and lentils

• nuts and nut butters.

Your child doesn’t need to eat every one of these.

The goal is to include protein-rich foods that your child can tolerate and enjoys.

🥑 Energy matters too

A child who is struggling to gain weight may need more energy without necessarily needing much larger meals.

Depending on what they tolerate, energy can sometimes be increased by adding foods such as:

• avocado

• olive oil

• nut butter

• full-fat dairy or suitable alternatives

• eggs

• smoothies

• nutritional supplements recommended by their healthcare team.

A paediatric dietitian can help you increase nutritional intake without making meals overwhelming.

🧲 Iron and other nutritional deficiencies

Children with IBD can develop nutritional deficiencies.

Your child’s team may monitor nutrients such as:

• iron

• ferritin

• vitamin D

• vitamin B12

• folate

• zinc

• calcium.

Iron deficiency and anaemia are particularly important to monitor because they can contribute to tiredness, weakness and difficulty concentrating.

Your child’s blood results should be interpreted in the context of their overall health and inflammation.

Don’t start high-dose supplements without discussing them with your child’s healthcare team.

The right supplement and dose depend on your child’s age, blood results, diet and medical treatment.

🦴 Bone health

Bone health is another important consideration for children with IBD.

Growing children need adequate nutrition, calcium and vitamin D to support healthy bones.

Your child’s healthcare team may pay particular attention to bone health if they have:

• ongoing active inflammation

• nutritional deficiencies

• poor growth

• low weight

• limited dietary intake

• prolonged or repeated corticosteroid treatment.

Your child’s team can advise whether they need additional monitoring or supplementation.

🌱 Puberty and IBD

Growth isn’t only about height.

Puberty is also an important part of healthy development.

Active IBD and poor nutritional status can sometimes contribute to delayed puberty.

If your child appears to be developing later than expected, mention this to their IBD team.

They can assess your child’s growth and development and decide whether further evaluation is needed.

🔥 What happens to nutrition during a flare?

During an IBD flare, eating can become difficult.

Your child may have:

• diarrhoea

• abdominal pain

• nausea

• reduced appetite

• urgency

• fatigue

• weight loss.

They may naturally eat less because they don’t feel well.

During this time, focus on fluids, nutrition and foods your child can comfortably tolerate.

Smaller, more frequent meals can sometimes be easier than large meals.

Some children temporarily tolerate softer or lower-fibre foods better, while others can continue eating a broad diet.

There isn’t one flare diet that works for every child.

🚫 Should I put my child on a restrictive diet?

Be careful with restrictive diets.

It can be tempting to remove dairy, gluten, sugar, fruit, vegetables or other foods because you’ve heard that they might “cause inflammation”.

But unnecessarily removing food groups can make it harder for a growing child to meet their nutritional needs.

A food that causes symptoms also isn’t necessarily causing the underlying IBD inflammation.

If you’re considering an elimination diet or major dietary change, discuss it with your child’s IBD team or an IBD-focused paediatric dietitian first.

🥤 What if my child can’t eat enough?

If your child is struggling to meet their nutritional needs through normal meals, their healthcare team may recommend additional nutritional support.

This could include:

• oral nutritional supplements

• additional snacks

• fortified foods

• dietitian-guided meal plans

• enteral nutrition.

For some children with Crohn’s disease, exclusive enteral nutrition (EEN) may be used as a treatment to induce remission. This is a specialised medical nutrition therapy and should only be undertaken with guidance from the child’s IBD team and dietitian.

Paediatric IBD nutrition guidance recognises nutritional therapy as an important part of managing some children with IBD.

💬 When should I ask to see a dietitian?

You don’t have to wait until your child’s nutrition becomes a major problem.

Ask about a paediatric or IBD-focused dietitian if your child:

• is losing weight

• isn’t growing as expected

• has a poor appetite

• is eating very little

• avoids many foods

• has nutritional deficiencies

• has ongoing diarrhoea

• struggles to eat during flares

• needs nutritional supplements

• is following a specialised diet

• has concerns about food or eating.

A dietitian can help make sure dietary changes don’t unintentionally leave gaps in your child’s nutrition.

❤️ Nutrition isn’t about perfection

Your child doesn’t need to eat a “perfect” diet.

There will be days when they eat very well and days when they don’t.

There will be birthday parties, school lunches, takeaway meals, holidays and days when the safest food is simply the food your child can manage.

What matters most is the overall picture over time.

The goal is to support your child’s:

Growth.

Nutrition.

Energy.

Bone health.

Puberty and development.

IBD treatment.

Relationship with food.

Quality of life.

📋 Questions to ask your child’s IBD team

At your next appointment, you could ask:

• Is my child’s growth tracking as expected?

• Has their growth pattern changed since their IBD symptoms started?

• Is their weight where you would expect it to be?

• Are they getting enough calories and protein?

• Should we see an IBD dietitian?

• Does my child need blood tests for nutritional deficiencies?

• Should we check iron and ferritin?

• What about vitamin D, calcium, B12, folate or zinc?

• Is my child’s puberty and development progressing normally?

• Does their current treatment support healthy growth?

• Should we be doing anything differently with their diet?

• Would nutritional supplements be helpful?

• When should we check their growth again?

🌟 The takeaway

Nutrition is a core part of caring for children with IBD.

If your child has Crohn’s disease or ulcerative colitis, their healthcare team should consider not only their symptoms and inflammation, but also their growth, nutritional status and development.

You don’t need to figure out your child’s nutritional needs alone.

If you’re worried about weight, growth, food intake or nutritional deficiencies, speak with your child’s IBD team and ask whether an IBD-focused paediatric dietitian can help.

Supporting nutrition isn’t about finding the perfect diet.

It’s about helping your child grow, develop, feel well and live as normally as possible while their IBD is being treated.