IBD and school: What teachers need to know

A practical guide for teachers supporting a student with Crohn’s disease or ulcerative colitis at school.

A student with inflammatory bowel disease (IBD) may look completely well one day and struggle the next.

IBD is a chronic condition that causes inflammation in the digestive system. The two main types are Crohn’s disease and ulcerative colitis.

For a child or teenager, IBD doesn't stop when they walk through the school gates. Symptoms, appointments, medication, fatigue and flares can all affect their school day.

The good news is that with the right understanding and support, students with IBD can participate fully in school life.

You don't need to be an IBD expert.

A little knowledge, flexibility and understanding can make a huge difference.

What is IBD?

IBD is an ongoing condition involving inflammation in the gastrointestinal tract.

Students with IBD may experience periods when their disease is well controlled, known as remission, and periods when symptoms become more active, known as a flare.

IBD is not contagious.

A student cannot catch Crohn's disease or ulcerative colitis from another student.

What might IBD look like at school?

IBD can affect students in different ways.

Some children may have obvious symptoms, while others may not show any signs that they are unwell.

During a flare, a student may experience:

• Urgent or frequent trips to the toilet

• Diarrhoea

• Abdominal pain or cramping

• Blood or mucus in their bowel movements

• Fatigue

• Reduced appetite

• Nausea

• Difficulty concentrating

• Feeling generally unwell

• Anxiety about needing the toilet

• Accidents or near-misses

A student may also need to leave class suddenly.

This isn't them trying to avoid class or get out of work. They may genuinely need to get to a toilet immediately.

Toilet access is essential

For many students with IBD, toilet access is one of the most important accommodations at school.

Urgency can mean that a student doesn't have time to wait.

They may need to:

• Leave class without asking permission

• Use the toilet during lessons

• Use a toilet that is closer to their classroom

• Use a private or accessible toilet

• Go to the toilet more than once during a lesson

• Leave an assembly, excursion or activity unexpectedly

A student should never be made to feel embarrassed or punished for needing the toilet.

A simple arrangement such as allowing the student to quietly leave the classroom can make a huge difference.

What if they have an accident?

This can be one of the most frightening things for a young person with IBD.

An accident may happen despite their best efforts.

If it does:

Stay calm.

Avoid drawing attention to what has happened.

Give the student privacy and help them access their spare clothes or contact their parent/carer according to their individual plan.

Most importantly, never shame, punish or embarrass a student because of an accident.

For some children, the fear of an accident can be more distressing than the accident itself.

Fatigue is real

One of the less visible effects of IBD is fatigue.

A student may have had a full night's sleep and still be exhausted.

Fatigue can be related to active inflammation, anaemia, nutritional deficiencies, disrupted sleep or the overall impact of living with a chronic illness.

You might notice that a student:

• Seems unusually tired

• Has difficulty concentrating

• Works more slowly

• Needs additional breaks

• Doesn't participate in sport

• Becomes irritable or withdrawn

• Struggles more later in the school day

This doesn't necessarily mean the student isn't trying.

Sometimes their body simply doesn't have the same amount of energy available.

What happens during a flare?

A flare is a period when IBD becomes more active and inflammation increases.

During a flare, a student may suddenly need more support.

They might:

• Miss more school

• Need frequent toilet breaks

• Arrive late

• Leave school early

• Have difficulty concentrating

• Need extra rest

• Struggle with sport or physical activities

• Need flexibility with assignments and deadlines

• Attend medical appointments

A flare can last for different amounts of time, and every student experiences IBD differently.

The goal isn't to lower expectations permanently. It's to provide flexibility when the student is genuinely unwell.

Medication at school

Some students need medication during the school day.

Depending on the student's treatment, this may involve tablets, liquids, injections or other therapies.

School staff should follow the student's individual medication plan and school policies.

Teachers don't need to know every detail of a student's treatment, but the appropriate staff should understand:

• What medication the student needs

• When it needs to be taken

• Who is responsible for administering it

• What to do if a dose is missed

• Who to contact if there is a problem

Never advise a student to stop or change their medication.

Medication decisions should be made by the student's healthcare team and family.

What about schoolwork?

IBD can sometimes affect a student's ability to keep up with schoolwork.

This may be because of:

• Medical appointments

• Hospital visits

• Absences during a flare

• Fatigue

• Pain

• Poor sleep

• Difficulty concentrating

• Time spent in the bathroom

A student may need temporary adjustments such as:

• Extra time for assignments

• Flexible deadlines

• Reduced workload during a significant flare

• Access to class notes

• Support catching up after an absence

• Alternative arrangements for missed assessments

Try to distinguish between temporary support during illness and the student's usual academic ability.

A student who is struggling during a flare may still be capable of their normal standard of work when they are well.

Physical education and sport

Having IBD doesn't automatically mean a student can't participate in sport.

Many young people with IBD participate in physical activity and competitive sport.

However, during a flare or period of significant fatigue, they may need to reduce or modify their activity.

The student, family and healthcare team can help determine what is appropriate.

If a student says they aren't feeling well, take that seriously rather than assuming they are simply trying to avoid PE.

School camps and excursions

School camps and excursions can be exciting — but they can also be a major source of anxiety for a student with IBD.

Before an excursion or camp, consider:

• Where the toilets are

• How quickly the student can access them

• Whether they have access to spare clothing

• Who the student can approach if they become unwell

• Medication requirements

• Food and dietary needs

• Access to drinking water

• What happens if the student needs to go home

• How privacy will be maintained

Talk to the family before the event, rather than leaving the student to work out what to do on the day.

A good plan can make the difference between a student feeling confident enough to attend and deciding they can't go.

Food and IBD

Teachers may notice that a student has particular dietary needs.

It's important to understand that there isn't one diet that causes or cures IBD.

Some children may have specific dietary recommendations from their doctor or dietitian.

Others may find that certain foods make their symptoms worse, particularly during a flare.

Avoid commenting on how much a student is eating or what they are eating unless there is a specific medical reason to do so.

If the student has dietary restrictions, follow the information provided by the family and school.

IBD and mental wellbeing

Living with IBD can affect a young person's emotional wellbeing.

Students may worry about:

• Having an accident

• Other students noticing their symptoms

• Smelling

• Using the toilet frequently

• Being teased

• Missing school

• Falling behind

• Being different from their friends

• Medical procedures

• Whether they will have a flare at school

Some students become very good at hiding how they are feeling.

A child who appears fine may still be experiencing significant anxiety.

A trusted teacher can make a huge difference simply by being someone the student knows they can approach without embarrassment.

Privacy matters

IBD is personal.

A student should have control over who knows about their condition and what information is shared.

Only share information with staff who need to know to support the student's health, safety and education, following the school's policies and the family's agreed plan.

Avoid discussing a student's IBD in front of classmates.

A student may not want other children to know why they are leaving class frequently or why they sometimes need special arrangements.

Don't make assumptions

IBD can be an invisible illness.

A student might:

• Look completely healthy

• Participate normally one day

• Struggle significantly the next

• Miss school but still want to keep up with their work

• Need frequent toilet breaks without appearing sick

• Be tired even after sleeping

• Have periods where they need very little support

Try not to judge a student's health by how they look.

What can teachers do?

The most helpful thing you can provide is understanding and flexibility.

Make toilet access easy

Allow the student to leave without unnecessary questions or delays.

Create a discreet system

Agree on a simple way for the student to leave class if they need the toilet.

They shouldn't have to explain their symptoms in front of classmates.

Have a backup plan

Know what happens if the student has an accident, becomes unwell or needs to go home.

Communicate with the family

Keep communication open and follow the student's agreed health and support plan.

Support missed work

Help the student prioritise what they need to catch up on rather than overwhelming them with everything they missed.

Watch for changes

If a student who normally participates becomes increasingly tired, withdrawn or frequently absent, let the appropriate school staff and family know.

Protect their dignity

This may be the most important one.

Don't make their IBD a bigger part of their school identity than it needs to be.

What should a school plan include?

Every child is different, but an individual support plan may include:

Toileting

• Immediate toilet access

• Permission to leave class without waiting

• Access to a suitable toilet

• A plan for accidents

Medication

• Medication requirements

• Who is responsible

• Emergency contacts

• What to do if medication is missed

Learning

• Flexibility with deadlines

• Support after absences

• Assessment adjustments where appropriate

Physical activity

• What to do during a flare

• When the student needs to sit out

• How they can safely participate when well

Communication

• Parent/carer contact

• Relevant school staff

• Student preferences about privacy

Emergencies

• What symptoms require immediate action

• Who to contact

• When the student needs to go home or seek medical attention

The student's family and healthcare team can help the school develop an appropriate plan.

What NOT to say

Sometimes a simple comment can make a child feel embarrassed or misunderstood.

Try to avoid:

❌ “Can't you just wait?”

❌ “You were just at the toilet.”

❌ “You look fine to me.”

❌ “Are you sure you really need to go again?”

❌ “You need to catch up because everyone else has.”

Instead, try:

✅ “Of course. Go ahead.”

✅ “Let me know if you need anything.”

✅ “We'll work out a plan for catching up.”

✅ “Take the time you need.”

The most important thing teachers can know

A student with IBD is still a student first.

They want to learn, make friends, play sport, go on camps, participate in school activities and feel like everyone else.

IBD may sometimes get in the way.

Your role isn't to treat their IBD — that's what their healthcare team does.

Your role is to create a school environment where they can manage their condition without unnecessary embarrassment, barriers or stress.

A little flexibility can help a child stay engaged with school during some of their hardest days.

And sometimes, the most helpful thing a teacher can say is simply:

“I've got you. Go to the toilet. We'll sort everything else out later.”