Inflammatory Bowel Disease (IBD)

Crohn's disease and ulcerative colitis are the most common forms of chronic (or long-term) inflammation (or swelling) in the intestine (the bowel). A way to visually understand the inflammation is to think of someone with arthritis causing a swollen joint or to think of a cut that became sore but to then imagine that the sore never completely healed.

While Crohn's disease and ulcerative colitis can begin in adults, they can also begin in childhood with approximately 25% of patients with Crohn's disease beginning to have problems before they are 20 years old. Approximately 10-15% of those with ulcerative colitis will develop the disease in childhood and adolescence, meaning that in kids, about twice as many will have Crohn's as ulcerative colitis. (In adults, they seem to occur about equally). Children with IBD (pediatric IBD) tend to have more severe disease and in ulcerative colitis, more of the large intestine may be inflamed.

The Symptoms

The main symptoms are similar for both diseases:

  • Abdominal pain
  • Diarrhea
  • Intestinal bleeding
  • Joint and skin problems can occur in both
  • Growth problems

Those with ulcerative colitis tend to have more diarrhea and bleeding while those with Crohn's disease have more growth problems and they can have problems including skin thickening and draining tracts (fistulas) from the intestine to the skin near the rectum.

Patients with IBD have a problem with their immune systems responding (often over-responding) to a yet-to-be-determined trigger. The primary treatments are medications decrease inflammation or prevent the immune system from overreacting.

Nutrition in Pediatric IBD

Those with IBD have a difficult time

  • Absorbing certain nutrients
  • As many as 25% lose weight
  • Some become anemic and malnourished
  • Growing to their potential
  • Some foods seem to cause more diarrhea, pain and bleeding

As a result, greater emphasis is now placed on providing adequate protein, calories and nutrients; assisting the patient's metabolism and growth and returning the kids to healthful functioning through active nutritional support.

Enteral Nutrition provides liquid nutrition either by mouth or through tube feedings into the stomach as either sole therapy on in combination with medications for Crohn's disease. It is usually used for short periods when the disease is first recognized or when the disease is flaring. Because enteral nutrition is difficult to tolerate for long-term treatment and because no studies have been done to provide evidence of its long-term safety, patients are usually transferred onto medication or another, more comprehensive diet.

The Specific Carbohydrate Diet (SCD) has been used by numerous adult patients with a variety of different illnesses including IBD, with many reporting long term success. However, that experience is just now being collected and scientifically analyzed. So far there have been a few small studies in pediatric Crohn's disease showing improvement when patients follow the diet closely.
Other diets have been promoted and used with less scientific and medical scrutiny and therefore, can't be recommended. It's also important to note that restrictive diets in childhood sometimes eliminate important vitamins and minerals, are difficult to maintain and can cause emotional trauma for some children and teens.

Irrespective of the chosen diet, and even when kids consume what they normally do, they need to consume additional protein and calories, and adequate vitamins and minerals to compensate for the additional needs they have with IBD. As a result, it's essential that the patients are monitored for their general and nutritional and disease activity.