Information for parents
Inflammatory Bowel Disease in Children
Inflammatory bowel disease (IBD) is an umbrella term, mainly covering Crohn’s disease and ulcerative colitis. Both cause long-term inflammation of the gut, and both can begin in childhood or adolescence.
IBD is not the same as IBS (irritable bowel syndrome). IBS is a disorder of gut-brain interaction without inflammation; IBD involves visible inflammation of the gut that needs specific treatment.
Crohn’s disease
Crohn’s disease can affect any part of the gut from the mouth to the bottom, most commonly the end of the small bowel and the colon. Inflammation can occur in patches and extend through the bowel wall.
Ulcerative colitis
Ulcerative colitis affects the colon (large bowel), starting at the rectum and extending continuously upwards. It involves the inner lining of the bowel and often causes bloody diarrhoea.
Symptoms of childhood IBD
Symptoms vary between children and can come on gradually. They may include:
- Diarrhoea, sometimes waking a child at night
- Blood or mucus in the poo
- Abdominal pain
- Weight loss or reduced appetite
- Poor growth — sometimes the only early sign, particularly in Crohn’s disease
- Delayed puberty
- Tiredness and low energy, sometimes from anaemia
- Perianal symptoms such as skin tags, fissures, abscesses or fistulas
- Symptoms outside the gut, such as mouth ulcers, joint pain, skin rashes or eye inflammation
Diagnosis
There is no single test for IBD. A paediatric gastroenterologist combines several pieces of information:
- Growth assessment — reviewing height and weight over time and pubertal development
- Blood tests — looking for anaemia, inflammation and nutritional status
- Stool tests, including faecal calprotectin, a marker of bowel inflammation, and tests to exclude infection
- Gastroscopy — examining the upper gut
- Ileocolonoscopy — examining the colon and the end of the small bowel
- Biopsies — tiny samples that confirm inflammation and help tell Crohn’s disease from ulcerative colitis
- Small bowel imaging when indicated, such as MRI, to assess parts of the bowel the scope cannot reach
Treatment
Treatment of paediatric IBD has advanced considerably. The goals are to control inflammation, relieve symptoms, allow normal growth and development, and heal the bowel lining (mucosal healing) where appropriate — so children can get on with school, sport and friendships.
Depending on the type and severity of disease, treatment may involve:
- Nutritional therapy — for example exclusive enteral nutrition, a period of complete liquid nutrition that is an effective first-line option for many children with Crohn’s disease
- Anti-inflammatory and immune-modifying medications
- Biologic and other advanced therapies for moderate to severe or persistent disease
- Surgery for selected children when needed
- Support from a multidisciplinary team including dietitians, nurses and psychologists
When should I be concerned?
See your GP promptly, and ask about specialist review, if your child has:
- Blood in the poo, especially with diarrhoea
- Ongoing diarrhoea, particularly waking at night
- Unexplained weight loss, poor growth or delayed puberty
- Persistent abdominal pain with other symptoms
- Perianal skin tags, abscesses or fistulas
- Mouth ulcers, joint pain or unexplained anaemia
Seek urgent care for severe abdominal pain, heavy bleeding, high fever or signs of dehydration.
When should my child see a paediatric gastroenterologist?
Diagnosis usually involves gastroscopy and colonoscopy — see our guide to paediatric endoscopy in Brisbane.
Children with suspected or confirmed IBD should be assessed and cared for by a paediatric gastroenterologist. Inflammatory bowel disease is one of Dr Malik’s areas of clinical and research interest.
Straight answers
Questions parents often ask
Does blood in my child’s poo mean IBD?
Not usually. Blood is more often caused by a small tear from constipation, infections or, in babies, milk allergy. However, blood in the poo should always be checked, especially with diarrhoea, pain or weight loss.
Is IBD the same as IBS?
No. IBD involves inflammation of the gut that can be seen on tests and biopsies. IBS is a disorder of gut-brain interaction without inflammation.
What is faecal calprotectin, and what does a high result mean?
Faecal calprotectin is a simple stool test that measures a protein released by white blood cells when the bowel is inflamed. A normal result makes IBD much less likely and can help avoid unnecessary procedures. A raised result suggests inflammation in the gut, but it is not specific to IBD — infections, some medicines and other conditions can also raise it, and levels are naturally higher in babies and young children. A persistently raised result, especially with symptoms such as diarrhoea, blood in the poo or weight loss, usually warrants review by a paediatric gastroenterologist. Calprotectin is also used to help monitor how well IBD is controlled over time.
Can children get Crohn’s disease?
Yes. Crohn’s disease and ulcerative colitis can begin in childhood, most often in older children and teenagers, and occasionally in young children.
Will my child need a colonoscopy?
Colonoscopy with biopsies, usually together with a gastroscopy, is an important part of diagnosing IBD. It is performed under anaesthetic care in children.
Can a child with IBD go to school and play sport?
Yes. With good disease control, most children with IBD attend school, play sport and take part in normal activities.
Will IBD affect growth?
Active inflammation can affect growth and puberty, which is why controlling it well is a key treatment goal. Growth is monitored closely.
Is IBD lifelong?
IBD is a long-term condition, but many children spend long periods well, in remission, with effective treatment.
Related children’s gut-health resources
Gastroscopy and Colonoscopy in Children
What to expect before, during and after your child’s procedure.
Abdominal Pain in Children
Common causes of recurring tummy pain and the signs that deserve a closer look.
Coeliac Disease in Children
Testing, when a gastroscopy is needed, and why not to stop gluten too early.
If your child has persistent gastrointestinal symptoms or your GP has recommended specialist assessment, you can find information about appointments with Dr Rohan Malik here.