What does an IBD flare look like?

One of the biggest questions parents have after their child is diagnosed with IBD is:

“How will I know if they’re having a flare?”

An IBD flare is a period when inflammation becomes active and your child’s symptoms return or become worse after a period of feeling well. Flares can look different from one child to another — and they may not always look exactly like previous flares.

Learning your child’s usual symptoms can help you notice changes early and know when it’s time to contact their IBD team.

What is an IBD flare?

IBD includes Crohn’s disease and ulcerative colitis. Both conditions can have periods of active inflammation and periods of remission, when symptoms are much better or absent.

A flare can happen suddenly or develop gradually. Some children may have several symptoms at once, while others may notice only one or two changes at first.

Your child’s IBD team should ideally help you develop a flare plan that explains what to look out for, who to contact and what to do if symptoms return.

🚽 Changes in poo

Changes in bowel habits are often one of the first things parents notice.

Your child may:

• Have diarrhoea or looser stools

• Need to poo more often than usual

• Suddenly need to get to the toilet urgently

• Have blood in their poo

• Have mucus in their poo

• Have accidents because they cannot get to the toilet in time

• Feel like they still need to poo even after going

The important thing is not necessarily a particular number of bowel movements. A noticeable change from what is normal for your child can be important. 

🤕 Tummy pain

Abdominal pain or cramping can occur during an IBD flare.

You might notice that your child:

• Complains of tummy aches more often

• Holds or rubs their stomach

• Avoids activities because of pain

• Wakes during the night because of discomfort

• Says their tummy hurts before or after going to the toilet

• Has pain that doesn’t settle

Persistent or worsening abdominal pain should be discussed with your child’s healthcare team.

😴 They seem much more tired

Fatigue can be an important part of IBD.

Your child might:

• Seem unusually tired

• Want to sleep more

• Have less energy for sport or playing

• Struggle to concentrate at school

• Come home from school exhausted

• Become more irritable or withdrawn

Fatigue can have many causes, so it doesn’t automatically mean your child’s IBD is flaring. But a noticeable change from their usual energy levels is worth mentioning to their IBD team.

🍽️ Their appetite changes

Some children eat less when they are experiencing abdominal pain, nausea or other symptoms.

You might notice:

• A reduced appetite

• Eating smaller meals

• Avoiding certain foods because they associate them with pain

• Feeling sick

• Vomiting

• Losing weight

If your child is consistently eating less or losing weight, let their healthcare team know. Weight, nutrition and growth are particularly important to monitor in children with IBD.

📏 Growth can be affected

IBD can affect a child’s growth and development, particularly when inflammation is active or nutritional needs are not being met.

Your child’s healthcare team may monitor:

• Height

• Weight

• Growth over time

• Puberty and development

A change in growth is not something you are necessarily going to notice from day to day. This is why regular appointments and growth measurements are important.

🌡️ Other signs to watch for

A flare may sometimes involve symptoms outside the bowel as well.

Your child may experience:

• Fever

• Joint pain or swelling

• Mouth ulcers

• Skin changes or rashes

• Eye symptoms

• Increased fatigue

Not every symptom outside the gut means that your child’s IBD is active, but new or unusual symptoms should be mentioned to their healthcare team.

What does a flare actually look like?

There isn’t one specific picture of an IBD flare.

For one child, it might look like:

“They’re suddenly going to the toilet six times a day and there’s blood.”

For another:

“They’re complaining of tummy pain, barely eating and coming home from school exhausted.”

And sometimes the changes are much more subtle.

You may simply notice:

“They’re just not themselves.”

As you get to know your child’s IBD, you may start recognising their own early warning signs.

Keep an eye out for changes from their normal

Rather than looking for one specific symptom, think about what is different for your child.

You could keep track of:

• Number of bowel movements

• Stool consistency

• Blood or mucus

• Urgency

• Tummy pain

• Appetite

• Energy levels

• Weight

• Temperature

• Sleep

• Joint or other symptoms

• School attendance and activities

A simple symptom tracker can make it easier to see whether things are changing and give your IBD team useful information.

Is every tummy ache a flare?

No.

Children with IBD can still get ordinary tummy bugs, constipation, food-related symptoms and other illnesses. Symptoms can also occur for reasons that are not related to active intestinal inflammation.

That means you don’t have to work out on your own whether it is definitely a flare.

If your child’s symptoms are new, persistent or getting worse, contact their IBD team and ask what they recommend. They may want to assess your child and use blood or stool tests, such as faecal calprotectin, to help determine whether inflammation is active.

When should I contact the IBD team?

Contact your child’s IBD team if you notice symptoms that could indicate a flare, particularly if they are persistent, worsening or similar to your child’s previous flares.

It can be helpful to tell them:

• What symptoms your child has

• When they started

• How often they are happening

• Whether there is blood or mucus

• Whether your child has a fever

• Whether they are eating and drinking normally

• Whether their energy has changed

• Whether they have lost weight

• What medications they are currently taking

Don’t change or stop your child’s IBD medication unless their healthcare team tells you to.

Your child’s team may already have a written flare plan for you to follow.

🚨 When does my child need urgent medical care?

Some symptoms need urgent assessment.

Seek urgent medical care if your child is very unwell, has severe or worsening abdominal pain, significant bleeding, persistent vomiting, signs of dehydration, a high or persistent fever, becomes unusually sleepy or difficult to wake, or you are seriously concerned about their condition.

If you’re unsure how urgent your child’s symptoms are, contact their healthcare team or local medical service for advice.

A flare plan can make things less frightening

Having a plan before your child becomes unwell can make a big difference.

Ask your IBD team:

• What are my child’s early warning signs?

• Who should I contact if symptoms return?

• What tests might be needed?

• When should we repeat blood or stool tests?

• What should we do about medications?

• When should my child stay home from school?

• When should we seek urgent medical care?

• Who should I contact outside normal clinic hours?

Keep the plan somewhere easy to find — and make sure other caregivers know where it is too.

Remember: you know your child

You don’t need to become an expert in interpreting every symptom.

You are learning what your child’s IBD looks like.

A flare may be obvious, or the first sign may simply be a change in their usual bowel habits, energy, appetite or behaviour. If something doesn’t feel right, it’s okay to contact the IBD team and ask.

The earlier changes are recognised and discussed with your child’s healthcare team, the sooner they can decide what needs to happen next.

You don’t have to figure it all out on your own.