Paediatric Inflammatory Bowel Disease

(For detailed eTG-based dosing, biologics and full management, see inflammatory bowel disease in gastroenterology — this page covers paediatric-specific presentation and induction-therapy pearls.)

In the paediatric population, ulcerative colitis is less prevalent than Crohn’s disease — the reverse of the adult picture, where UC is more common overall.

Crohn’s disease

Abdominal pain; growth failure from malabsorption (a hallmark of paediatric-onset Crohn’s — may precede overt GI symptoms); diarrhoea, bleeding, fistulae. May not have bloody diarrhoea if disease is more proximal (small bowel) — don’t rule Crohn’s out just because stools aren’t bloody.

Upper gastrointestinal involvement (nausea, vomiting, epigastric pain) is more common in paediatric-onset Crohn’s than in adult disease. When cross-sectional imaging is needed, MRI is generally preferred over CT in children because of the cumulative radiation-exposure difference.

Ulcerative colitis

Bloody diarrhoea; urgency and tenesmus; abdominal pain. Growth retardation in a child is itself one of the recognised indications for colectomy when medical therapy fails, alongside the standard adult indications (fulminant colitis, toxic megacolon, perforation, uncontrolled bleeding, dysplasia/cancer).

Induction therapy — exclusive enteral nutrition

Exclusive enteral nutrition (EEN) — a complete nutritional feed, no other oral intake, for around 6–8 weeks — is first-line induction therapy in paediatric Crohn’s disease, avoiding the growth-suppressing and cosmetic side effects of corticosteroids in a still-growing child. A 2018 Cochrane review found very-low-quality evidence that EN may be more effective than steroids for inducing remission in children (the opposite direction to adults, where steroids appeared more effective) — low quality because of small trial numbers, not a doubted clinical effect; EEN remains standard first-line in paediatric gastroenterology. Formula palatability is the main practical limitation, driving more withdrawals than with steroids.

Practical notes

• Growth faltering is often the presenting or most concerning feature in children — measure height, weight and pubertal staging at every review.
• Faecal calprotectin is a useful non-invasive first-line screen when IBD is suspected, before referral for endoscopy. A low result makes IBD unlikely — fewer than 1% of patients with a low faecal calprotectin turn out to have IBD — though the test is non-specific and doesn’t distinguish IBD from other causes of intestinal inflammation.
• Refer to paediatric gastroenterology for diagnostic colonoscopy/endoscopy and biologic therapy decisions — don’t delay referral in a child with red flags (growth faltering, persistent bloody diarrhoea, perianal disease, unexplained anaemia).