What is a flare?

Understand what a flare is, why it happens, and what to look for.

If your child has IBD, you may eventually hear the words “flare” or “flare-up.” A flare can be one of the more worrying parts of living with Crohn’s disease or ulcerative colitis, particularly when you are trying to work out whether a change in symptoms is something to watch or something that needs medical attention.

The good news is that once you understand your child’s usual pattern, you can become much better at recognising when something is changing and knowing when to contact their IBD team.

What is an IBD flare?

An IBD flare is a period when the disease becomes more active and inflammation increases, causing symptoms to return or become worse.

Children can have periods when their IBD is well controlled and they have few or no symptoms. This is often called remission. A flare is a change from that more settled period, with symptoms suggesting that the IBD may be active again.

A flare can be mild, moderate or severe, and it can look different from one child to another. Your child may experience some symptoms but not others.

Importantly, a flare isn't simply defined by how unwell your child looks or feels. IBD inflammation can sometimes be present even when symptoms are subtle, which is why your child's IBD team may use blood tests, stool tests and other monitoring to assess what is happening.

What causes a flare?

There isn't always an obvious reason why a child has a flare.

IBD is a complex condition involving the immune system, genetics and the environment. A flare does not mean that you or your child have done something wrong.

Sometimes there may be a clear trigger or change around the time symptoms appear. Other times, symptoms can return without an obvious explanation.

This is why it is important not to assume that a flare was caused by one particular food, stress, something your child did, or something you did as a parent.

Your child's IBD team can help work out whether symptoms are due to active IBD or whether something else, such as an infection, could be causing them.

What does a flare look like?

The signs of a flare depend on whether your child has Crohn's disease or ulcerative colitis, where the inflammation is located, and how active the disease is.

Some common signs include:

🚽 Changes in bowel movements

You may notice your child:

• Going to the toilet more often

• Having looser or watery stools

• Having diarrhoea

• Suddenly needing to get to the toilet urgently

• Waking during the night to use the toilet

• Having more accidents or near-misses

• Having blood or mucus in their poo

• Having a noticeable change from their usual bowel pattern

  
  

For a child who normally has predictable bowel habits, a sustained change from their usual pattern can be an important early warning sign.

🤕 Tummy pain

Abdominal pain or cramping is another common symptom.

Your child may describe:

• A sore tummy

• Cramping

• Pain before or during a bowel movement

• Pain that comes and goes

• Feeling uncomfortable or bloated

  
  

Pay attention to a change from what is normal for your child, rather than looking for one particular type of pain.

😴 Tiredness and low energy

Fatigue is common during active IBD.

You might notice that your child:

• Doesn't have their usual energy

• Wants to sleep more

• Struggles to get through a normal school day

• Doesn't want to play or participate in sport

• Finds everyday activities harder than usual

• Seems unusually flat or irritable

  
  

Fatigue can have several causes, including inflammation and anaemia, so it is worth mentioning to your child's healthcare team.

🍽️ Appetite and weight changes

Your child may lose their appetite or become reluctant to eat because they associate eating with pain or needing to use the toilet.

You may also notice weight loss or difficulty maintaining their usual growth pattern.

For children, this is particularly important because growth and nutrition are part of monitoring IBD. If you notice a significant change in your child's appetite, weight or growth, let their IBD team know.

🌡️ Feeling generally unwell

Some children may develop a raised temperature or fever during active disease.

They may also simply seem different — less energetic, pale, off their food or generally unwell.

Don't assume that every fever or tummy upset is an IBD flare. Infections can cause similar symptoms, and your healthcare team may need to investigate the cause.

Flares can affect more than the gut

IBD is not only a bowel condition.

During active disease, some children can also experience symptoms outside the digestive system, including:

• Joint pain

• Mouth ulcers

• Skin rashes

• Red, painful or inflamed eyes

• Other inflammatory symptoms

  
  

These symptoms aren't present in every child, but they are worth mentioning to your child's IBD team.

How do I know if it's actually a flare?

This can be one of the hardest questions for parents.

You can't always tell from symptoms alone.

Diarrhoea, tummy pain, fatigue and changes in bowel habits can happen for many reasons. An infection, medication side effect or another gastrointestinal problem can sometimes look similar to an IBD flare.

Your child's IBD team may use a combination of:

• Your child's symptoms and usual bowel pattern

• Physical examination

• Blood tests

• Stool tests, including tests for inflammation

• Other investigations when needed

• 
  

This is why contacting the IBD team when your child's symptoms are changing can be so useful.

Know your child's "normal"

One of the most helpful things you can do as a parent is learn what well looks like for your child.

Think about:

• How often do they normally poo?

• Do they normally wake at night to use the toilet?

• Do they usually have urgency?

• Is there normally blood or mucus?

• How is their appetite?

• How much energy do they normally have?

• Are they maintaining their usual growth and weight?

• What symptoms does your child usually experience when their IBD becomes active?

  
  

When you know your child's baseline, changes can be easier to spot.

Some IBD resources recommend keeping track of bowel frequency, night-time stools and blood when symptoms are changing, as this can help you and the healthcare team identify patterns.

What should I do if I think my child is flaring?

Don't wait until your child is extremely unwell before getting in touch.

If your child develops persistent or worsening symptoms, contact their IBD team or follow the flare plan you have been given.

Your child's team may recommend monitoring symptoms at home, arranging blood or stool tests, reviewing medications, or seeing your child in clinic.

If your child has an individual IBD action plan, follow that plan rather than relying on general advice online.

And importantly, don't start, stop or change your child's IBD medication unless their healthcare team has advised you to do so.

When should I seek urgent medical help?

Some symptoms need prompt medical assessment.

Seek urgent medical advice if your child has symptoms such as:

• Severe or worsening abdominal pain

• Significant or large amounts of blood in their stools

• Signs of significant dehydration

• Persistent vomiting

• Severe abdominal swelling or pain

• A high fever, particularly if your child is taking an immunosuppressive medicine

• A child who is becoming very unwell, unusually sleepy, faint or difficult to wake

  
  

Crohn's & Colitis Australia specifically advises urgent medical attention for severe abdominal pain, significant bleeding, dehydration and certain combinations of fever and immunosuppressive treatment, among other red flags.

If you are concerned that your child is seriously unwell, seek urgent medical care rather than waiting for an appointment.

A flare is not a failure

It can be easy to feel like you've done something wrong when your child's symptoms return.

You haven't.

IBD is a chronic condition, and flares can happen even when your child is taking their medication and your family is doing everything you have been advised to do.

The aim of treatment is to control inflammation, reduce symptoms and help your child stay well, grow and get on with being a kid.

A flare is a signal that your child's IBD may need attention — not a sign that anyone has failed.

The most important thing to remember

You don't need to become an expert at diagnosing a flare yourself.

Your job is to notice changes, know what is normal for your child, keep track of important symptoms, and know when to contact their IBD team.

The earlier a change is recognised and discussed with the healthcare team, the sooner you can work out what is happening and what your child needs.