When does a flare need urgent medical attention?

Most IBD flares can be managed with support from your child’s IBD team. But sometimes symptoms can become severe and need urgent medical attention.

Knowing the warning signs can help you feel more confident about what to do if your child with Crohn’s disease or ulcerative colitis suddenly becomes very unwell.

The most important thing to remember is this:

If your child looks seriously unwell, don’t wait for the IBD team to call you back. Seek urgent medical care.

🚨 When is an IBD flare an emergency?

An IBD flare can become serious when your child is losing large amounts of fluid or blood, is unable to keep fluids down, or develops severe abdominal symptoms.

Seek urgent medical attention if your child has:

• Severe or worsening abdominal pain

• A very swollen, distended or unusually tender abdomen

• Heavy or ongoing rectal bleeding

• Large amounts of blood in their poo

• Repeated vomiting or vomiting that prevents them from drinking

• Signs of significant dehydration

• A high or persistent fever, particularly if they look very unwell

• Fainting, severe dizziness or unusual weakness

• A very fast heartbeat together with severe symptoms

• Difficulty staying awake, confusion or a significant change in alertness

• Severe diarrhoea with signs that they are becoming dehydrated

• Severe symptoms combined with an inability to pass poo or wind

These symptoms can sometimes indicate a serious complication or severe IBD flare and need prompt assessment.

💧 Watch carefully for dehydration

Diarrhoea and vomiting can cause children to lose a lot of fluid.

During an IBD flare, your child may be particularly vulnerable to dehydration if they are having frequent diarrhoea, vomiting or are not drinking enough.

Signs of dehydration can include:

• A very dry mouth or tongue

• Passing much less urine than usual

• Dark or concentrated urine

• Dizziness or light-headedness

• Unusual sleepiness or weakness

• Sunken eyes

• Being unable to keep fluids down

If you think your child is significantly dehydrated, seek medical advice urgently.

If they are very weak, difficult to wake, fainting or seriously unwell, seek emergency medical care.

🩸 What about blood in their poo?

Blood can occur during an ulcerative colitis or Crohn’s disease flare, but the amount and your child’s overall condition matter.

Contact your child’s IBD team if you notice new or increasing blood in their poo.

Seek urgent medical attention if there is:

• Heavy bleeding

• Bleeding that doesn’t stop

• Large amounts of blood

• Blood clots

• Bleeding together with severe abdominal pain, dizziness, weakness or fainting

• Bleeding and your child appears very unwell

Significant bleeding can cause blood loss and may require urgent assessment.

🤕 Severe abdominal pain should never be ignored

Tummy pain can be part of an IBD flare, but severe, constant or rapidly worsening abdominal pain is different from the mild cramping your child may normally experience.

Urgent assessment is particularly important if severe pain occurs with:

• A swollen or distended abdomen

• Fever

• Repeated vomiting

• Rapid heartbeat

• Significant bleeding

• Fainting or dizziness

• Inability to pass poo or wind

Severe abdominal pain and swelling can sometimes indicate complications such as a bowel obstruction or, in severe ulcerative colitis, toxic megacolon. These complications require immediate medical assessment.

🤢 What if my child is vomiting?

Occasional nausea or vomiting can happen for many reasons, including infections.

But persistent vomiting during a suspected IBD flare needs medical advice, particularly if your child:

• Cannot keep fluids down

• Is vomiting repeatedly

• Has worsening abdominal pain

• Has a swollen abdomen

• Is becoming very sleepy or weak

• Is passing very little urine

• Has blood in their vomit

Crohn’s disease can sometimes cause narrowing of the bowel, which can contribute to symptoms such as abdominal pain, vomiting and difficulty passing stool.

🌡️ What if they have a fever?

A fever does not automatically mean your child’s IBD is flaring.

Children can develop fevers from infections, and infections can sometimes cause symptoms that look similar to an IBD flare.

However, fever combined with significant abdominal pain, heavy bleeding, repeated vomiting or a child who looks seriously unwell should be assessed urgently.

Your child’s IBD team should also know about a new or persistent fever during a flare, particularly if your child is taking medication that affects the immune system.

😴 What if they suddenly become extremely tired?

Fatigue is common in children with IBD, particularly when inflammation is active.

But there is a difference between being tired and being unusually weak, difficult to wake or not behaving normally.

Seek urgent medical attention if your child:

• Is extremely weak

• Faints or nearly faints

• Is difficult to wake

• Seems confused

• Is unusually sleepy or unresponsive

• Has severe dizziness

• Looks very pale and unwell

These symptoms can occur with significant dehydration, blood loss or other serious illness.

🚽 What if they’re having lots of diarrhoea?

There isn’t one specific number of bowel movements that means a child needs emergency care.

What’s important is how severe the diarrhoea is and how your child is coping with it.

Contact the IBD team if your child is having substantially more bowel movements than usual, particularly if there is blood, mucus, pain, fever or urgency.

Seek urgent care if severe diarrhoea is accompanied by:

• Significant dehydration

• Heavy bleeding

• Severe abdominal pain

• Repeated vomiting

• Fainting or severe dizziness

• Extreme weakness

• A high fever or your child appearing seriously unwell

Everyone experiences an IBD flare differently, so your child’s own flare plan should take priority.

🩺 What should I do if I’m worried but it’s not an emergency?

Not every flare requires an emergency department visit.

If your child has new or worsening IBD symptoms but is otherwise stable, contact their IBD team.

This could include:

• More frequent diarrhoea

• Blood or mucus in their poo

• Increased urgency

• Ongoing tummy pain

• Reduced appetite

• Increased fatigue

• Weight loss

• Fever

• Vomiting that is not severe

• Symptoms that are similar to a previous flare

Your IBD team may recommend blood tests, stool tests such as faecal calprotectin, a medication review or an appointment to assess whether inflammation is active.

Children with IBD can have symptoms for reasons other than active inflammation, so your healthcare team may need to investigate before deciding whether a flare is occurring.

📋 Follow your child’s flare plan

Ideally, every child with paediatric IBD should have a plan for what to do when symptoms become worse.

Ask your IBD team:

• What symptoms should make us call you?

• What symptoms mean we should go to hospital?

• Who should we contact during office hours?

• Who should we contact after hours?

• What should we do if our child cannot take their medication?

• When should we arrange blood or stool tests?

• What should we do if there is blood in the stool?

• What signs of dehydration should we look for?

Keep your child’s plan somewhere easy to access.

You may also want to make sure other caregivers know what to do if your child becomes unwell.

❤️ You don’t have to decide whether it’s “really” a flare

One of the hardest things for parents can be deciding whether symptoms are serious enough to act.

You don’t have to diagnose an IBD flare yourself.

If your child has new or worsening symptoms, their IBD team can help determine what is happening and whether they need testing or treatment.

And if your child is seriously unwell, urgent medical care comes first.

When in doubt, trust what you see

You know what your child normally looks like, sounds like and behaves like when they’re unwell.

If something feels significantly different — particularly if they have severe pain, heavy bleeding, dehydration, repeated vomiting, a swollen abdomen, fainting or a major change in alertness — don’t wait and see if it passes.

Seek urgent medical attention.

For less severe changes, contact your child’s IBD team and follow their individual flare plan.

Having a plan in place before the next Crohn’s disease or ulcerative colitis flare can make an overwhelming situation feel much more manageable.