Inflammatory Bowel Disease (IBD)
What We Know About IBD
Inflammatory Bowel Disease (IBD) is the most common chronic condition we treat in pediatric gastroenterology. IBD is an umbrella term for two related conditions: Crohn’s Disease(CD) and Ulcerative Colitis(UC).
IBD occurs when the body’s immune system mistakenly attacks the lining of the digestive tract, causing inflammation, redness, and swelling. This leads to pain, diarrhea, bleeding, and sometimes problems with growth.
IBD is a lifelong condition, but with modern treatments and ongoing care, most children with IBD can grow, thrive, and live active lives.
Symptoms of IBD in Kids
- Abdominal pain or cramping
- Diarrhea (sometimes with blood or mucus)
- Vomiting
- Mouth sores
- Joint pain or swelling
- Poor appetite
- Poor growth or delayed puberty
- Weight loss
- Fatigue and anemia
💡 IBD is different in kids than in adults. Poor growth and delayed puberty can be some of the earliest signs of Crohn’s or ulcerative colitis in children.
Crohn’s Disease (CD) vs. Ulcerative Colitis (UC)
| Feature |
Crohn’s Disease (CD) |
Ulcerative Colitis (UC) |
| Location |
Can affect any part of the GI tract (mouth to anus), most often the small intestine and colon |
Limited to the colon (large intestine) |
| Pattern of inflammation |
Patchy (“skip lesions”) – normal areas between inflamed sections |
Continuous inflammation in affected areas |
| Depth of inflammation |
Can involve the full thickness of the bowel wall |
Limited to the innermost lining of the colon |
| Common symptoms |
Abdominal pain, diarrhea, poor growth, weight loss, delayed puberty, perianal disease (fistulas, abscesses) |
Bloody diarrhea, urgency, abdominal pain |
| Growth impact |
Growth and puberty delays are more common |
Less likely to cause growth delay |
| Extraintestinal symptoms |
Arthritis, skin rashes, mouth sores, liver problems (can occur in both CD and UC) |
Arthritis, skin rashes, liver problems (can occur in both CD and UC) |
How We Diagnose IBD
Since no single test can confirm IBD, we usually combine several approaches:
1. Endoscopy & Colonoscopy
Allows direct visualization of the digestive tract.
Biopsies are taken to confirm inflammation.
2. Imaging Studies
MR Enterography (MRE): Preferred for kids, no radiation
CT Enterography (CTE): Sometimes used in emergencies; does involve radiation
Ultrasound: Occasionally used to detect bowel wall thickening
3. Laboratory Tests
Bloodwork: CBC (anemia), CRP/ESR (inflammation), vitamin/mineral levels
Stool tests: Fecal calprotectin (intestinal inflammation marker), infection testing
Growth charts: Careful review of height, weight, and BMI
Treatment Options
The goal of therapy is both symptom control and healing of the intestinal lining (“mucosal healing”).
Biologic Medications
Anti-TNF medications are typically the first-line therapy for children with moderate to severe IBD.
Infliximab (Remicade) and Adalimumab (Humira) are the longest-studied biologics in children and have excellent safety and effectiveness records.
Other biologics like Vedolizumab (Entyvio) and Ustekinumab (Stelara) may also be used depending on response and disease characteristics.
Other Medical and Nutritional Therapies
Steroids (Prednisone, Budesonide): Used short term for flares; not for long-term therapy
Mesalamines (5-ASA, such as Sulfasalazine, Pentasa, Asacol): Sometimes used in UC; less effective in CD
Antibiotics (Metronidazole, Ciprofloxacin): Occasionally used for Crohn’s complications or infections
Dietary therapy: Exclusive enteral nutrition or specialized diets, especially in Crohn’s disease
Surgery: May be needed if medications are not enough or complications develop
Older / More Dated Therapies
Immunomodulators (Azathioprine, 6-MP, Methotrexate): Previously used as mainstay therapy but now less common as first-line due to slower onset and side effect profile. May still be considered in specific cases.
The Future of IBD Care
Advances in biologics, dietary therapies, and collaborative research have transformed outcomes for children with IBD. More children than ever are achieving remission, growing normally, and living full lives with careful management.
Resources
Crohn’s & Colitis Foundation – A national nonprofit dedicated to improving the lives of children and adults with IBD. Their site includes patient guides, videos, and resources for families of newly diagnosed children.
https://www.crohnscolitisfoundation.org
NASPGHAN – GIKids – The pediatric education site from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Offers easy-to-understand handouts, nutrition guides, and videos created specifically for children and families.
References
ï‚· NASPGHAN. GI Kids: Patient Education Resources. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. https://www.gikids.org
ï‚· American Academy of Pediatrics (AAP). Pediatric Gastroenterology Clinical Reports and Patient Education. https://www.aap.org
ï‚· Blaufuss, T. Common Sense Pediatric GI: Practical Guidance for Families. Dakota Pediatric Gastroenterology, Fargo, ND, 2025.
ï‚· Ruemmele FM, Veres G, Kolho KL, et al. Consensus Guidelines of ECCO and ESPGHAN on the Medical Management of Pediatric Crohn’s Disease. J Pediatr Gastroenterol Nutr. 2014;58(6):795-806.
ï‚· Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of Pediatric Ulcerative Colitis: Joint ECCO/ESPGHAN Guidelines. J Pediatr Gastroenterol Nutr. 2018;67(2):257-291.
ï‚· NASPGHAN. Inflammatory Bowel Disease (IBD). GI Kids.
ï‚· Crohn’s & Colitis Foundation. Pediatric IBD Resources. https://www.crohnscolitisfoundation.org