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Pediatrics: Caring for Kids & Teens With IBD
Last Updated Nov 11, 2025
Inflammatory bowel disease in childhood needs a care plan that protects growth, supports nutrition, and keeps vaccines up to date. Treatment choices may differ from adults, and family, school, and mental health supports matter as much as medicines. This guide highlights what is known about growth, bone health, nutrition therapies, iron, and vaccinations, and how families and schools can help children thrive.
Key takeaways
Track height, weight, and puberty at every visit, and act early if growth slows. (academic.oup.com)
For Crohn’s, exclusive enteral nutrition can induce remission without steroids in many children. (academic.oup.com)
All inactivated vaccines are safe on immunosuppression, live vaccines should be given before immunosuppressive therapy when possible. (cdc.gov)
Check for iron deficiency and vitamin D deficiency often, and treat to protect energy, learning, and bone. (pubmed.ncbi.nlm.nih.gov)
School 504 plans, peer programs, and camps reduce isolation and support adherence. (crohnscolitisfoundation.org)
Why pediatric IBD is different
Children and teens are still growing. Active intestinal inflammation can suppress appetite, reduce nutrient absorption, delay puberty, and weaken bones. Minimizing steroid exposure, achieving deep remission, and monitoring growth and puberty are core goals in pediatric care. Height velocity over 6 to 12 months, along with Tanner staging, gives the clearest picture of growth. (academic.oup.com)
Growth and bone health: what to monitor
Measurements at every visit: height (stadiometer), weight, body mass index z‑score, and pubertal stage. Consider bone age if growth is delayed. Refer to pediatric endocrinology for delayed puberty or very low height z‑scores. (mdpi.com)
Labs: vitamin D, calcium intake review, and inflammation markers. Treat vitamin D deficiency and support adequate calcium intake. Encourage regular weight‑bearing activity. (mdpi.com)
Imaging: bone density testing is considered when there is a vertebral or low‑trauma fracture, significant growth failure, persistent high steroid exposure, or very low vitamin D. Decisions are individualized. (pmc.ncbi.nlm.nih.gov)
Avoiding long courses of systemic steroids supports catch‑up growth. When disease is localized and refractory, surgery timed before puberty can sometimes help growth, but this is highly individualized. (academic.oup.com)
Nutrition and iron: cornerstones of pediatric care
Many children need more calories and protein during flares and catch‑up growth. A pediatric dietitian can tailor a plan that meets needs and fits family routines.
Nutrition approach | When it is used | Notes |
|---|---|---|
Exclusive enteral nutrition (EEN) | First‑line induction for luminal Crohn’s | Liquid formula replaces all food for about 6 to 8 weeks, similar remission rates to steroids, plus better mucosal healing and growth support. (academic.oup.com) |
Partial enteral nutrition with Crohn’s Disease Exclusion Diet (CDED+PEN) | Alternative induction or bridge | Whole‑food diet plus formula, better tolerated than EEN, with evidence for sustained remission in some studies. (pubmed.ncbi.nlm.nih.gov) |
Balanced food‑first plan in remission | Long term | Emphasize varied, nutrient‑dense foods, individualized for symptoms and preferences. Diets alone rarely control moderate to severe inflammation. (academic.oup.com) |
Iron deficiency is common and affects concentration and stamina. Screen with complete blood count, ferritin, and transferrin saturation, interpreting ferritin with inflammation. Oral iron works for many, but intravenous iron is safe and effective when oral iron fails or inflammation is high. (chop.edu)
Vaccinations and infection prevention
Review vaccine status at diagnosis and before starting immunosuppressive therapy. In general, inactivated vaccines are safe during treatment, while live vaccines are avoided during immunosuppression and given beforehand when possible. Household contacts should be fully vaccinated, including live vaccines, to protect the child. (cdc.gov)
Vaccine | Safe on immunosuppression | Key pediatric points |
|---|---|---|
Influenza (inactivated) | Yes | Yearly for everyone 6 months and older. Avoid nasal live vaccine when immunosuppressed. (cdc.gov) |
COVID‑19 | Yes | Use the current CDC schedule for people who are moderately or severely immunocompromised. (cdc.gov) |
HPV | Yes | Start at 9 to 12 years. If immunocompromised, use 3‑dose series. (cdc.gov) |
Pneumococcal | Yes | Children with IBD on immunosuppression should complete PCV series and receive PCV20 or PPSV23 per risk‑based guidance. PCV20 can complete the series. (cdc.gov) |
Hepatitis A/B | Yes | Check immunity to hepatitis B and revaccinate if non‑immune before or during therapy when indicated. (cdc.gov) |
MMR, Varicella (live) | No on immunosuppression | Give before starting immunosuppressants when possible. Household contacts can receive MMR and varicella, avoid close contact only if a varicella vaccine rash occurs. (cdc.gov) |
Medicines in pediatric IBD, in brief
Treatment aims for steroid‑free remission and normal growth. For Crohn’s disease, EEN or corticosteroids induce remission, with immunomodulators or biologics for maintenance. High‑risk features, such as severe growth delay or deep ulcers, may prompt earlier biologic therapy. Monitoring includes symptoms, fecal calprotectin, and imaging or endoscopy as needed. (academic.oup.com)
Family, school, and mental health
School supports: a Section 504 plan can provide bathroom access, “stop‑the‑clock” testing, flexible deadlines, and home tutoring during flares. Renew plans yearly. (crohnscolitisfoundation.org)
Peer connection: Camp Oasis and local or virtual support groups reduce isolation and build self‑management skills. (crohnscolitisfoundation.org)
Adherence: Teens face unique barriers, including forgetting and stigma. Simple routines, reminders, and family support improve medication adherence. (pubmed.ncbi.nlm.nih.gov)
Follow‑up and transition
Children benefit from a team that includes a pediatric gastroenterologist, dietitian, nurse, and mental health professional. Visits typically track symptoms, labs, stool calprotectin, growth, and puberty. Begin transition skills in early adolescence, and plan the move to adult care gradually. See the companion article, Transitioning From Pediatric to Adult Care. (academic.oup.com)
FAQs
Can kids with IBD play sports
Yes. Most can stay active, which supports bone strength and mood. Adjust during flares or fatigue and ensure good hydration and nutrition. (mdpi.com)
What if growth stalls despite treatment
Reassess inflammation control, nutrition intake, vitamin D status, and steroid exposure. Consider endocrinology referral and targeted imaging or labs. (academic.oup.com)
Are diet‑only plans enough
Diet therapies can help, especially in Crohn’s, but moderate to severe disease usually needs medicines plus nutrition support to protect growth and achieve deep remission. (academic.oup.com)