Pediatric IBD can interrupt your child’s digestion, affecting
his or her nutritional health. Good nutrition is especially
important for children with Pedi IBD to help them grow and
develop at a healthy rate.
What is healthy digestion?
Healthy digestion is the process our bodies use to break down
and absorb calories and nutrients from the foods that we
Once digestive enzymes have broken down the food, a healthy
digestive system absorbs the nutrients it needs to give the
body energy and keep it healthy. Any unused waste is
removed from the body in a bowel movement.
A healthy digestive system in children uses the calories and
nutrients from food to help the body grow and develop at a
How can Pedi IBD affect
my child's digestive system?
Pedi IBD can interrupt the healthy digestion of foods by causing
- inflammation of different parts of the intestine
Crohn’s disease can affect any part of a child’s intestine
from the mouth to rectum, most often affecting the lining of
the small intestine, and can cause problems such as
- poor appetite
- inability to absorb nutrients or vitamins and minerals
Ulcerative colitis involves the lining of a child’s large
intestine and can cause
What are nutritional deficiencies and how are they
Nutritional deficiencies can happen when your child is not
taking in enough
from the foods he or she is eating for them to grow and develop
at a normal and healthy rate.
If nutritional deficiencies are not corrected, they can become
a serious complication and can cause your child to have
- delayed growth and development
Many nutritional deficiencies can be avoided or reversed with
supplements prescribed by your child’s
- physician or gastroenterologist
Causes of nutritional deficiencies
Some of the causes of nutritional deficiencies can include
- poor food intake (not eating enough)
- reduced absorption and digestion
- medication use
Poor food intake
The most common reason for nutritional deficiencies in children
with Pedi IBD is not eating enough food or
When symptoms of Pedi IBD are active, many children do not
eat enough food or take in as many calories a day as their
bodies need to grow and thrive.
If your child’s Pedi IBD is active, he or she can experience
- abdominal pain
- a feeling of bloating
These symptoms can limit the amount of food that your child
can or wants to eat at one time.
Children with Pedi IBD may not be able to eat when feeling
nauseous, bloated or vomiting. Sometimes, children with Pedi
IBD can choose not to eat if eating causes diarrhea or stomach
pain or when they are afraid that they may have an accident.
This can happen especially when they are at school or somewhere
that a bathroom may not be close by.
Reduced absorption or digestion
Children with Crohn's disease are more affected by this problem
than children with ulcerative colitis.
If your child's Crohn's disease affects many areas of the
small intestine, the intestine may not be able to take in enough
- minerals (calcium and iron)
If your child’s Crohn’s disease affects the terminal ileum
where the small intestine joins the large intestine, the digestive
system may not be able to take in enough
Children who have had surgery to remove part of their small
intestine can also have these nutritional deficiencies.
is a major cause of loss of nutrients, calories, vitamins
and minerals as food moves through a child’s body before
the intestine has a chance to absorb what it needs to grow
and thrive. Children with both Crohn’s disease and ulcerative
colitis can frequently struggle with diarrhea.
Children with active disease or inflammation can have more
- protein loss in stool or hypo-albuminemia (low levels of
protein in blood)
- blood loss in diarrhea or iron deficiency that can become
- dehydration or low fluid and electrolyte levels
It is always important when your child is experiencing a bout
of diarrhea to make sure that he or she is drinking enough
fluids, especially drinks with electrolytes.
Some medications used to treat Crohn’s disease and ulcerative
- interfere with or stop some of the absorption of minerals/vitamins
Examples of medications that can interfere with the way your
child’s body absorbs or takes in an important vitamin like
folate (folic acid) are
Nutritional and dietary recommendations
for children with Pedi IBD
What your child eats or is able to eat can depend greatly on
whether their Pedi IBD is
- in remission and they are experiencing few symptoms
- or active and causing increased inflammation of the digestive
When your child’s disease is in remission or not active, the
goal is to
maintain a well balanced diet of a wide
variety of foods including
- protein — meats, fish, poultry, dairy products, beans,
- carbohydrates — cereals, breads, vegetables, fruit
- fats — oils, butter, margarine
A well balanced diet can help to make sure that your child
to help them grow and develop at a healthy rate.
When your child's Pedi IBD is active and they are experiencing
more symptoms, your healthcare provider may suggest special
nutritional recommendations that may be helpful during this
Special Nutritional Recommendations in Pedi IBD
When your child’s disease is active or they are experiencing
symptoms, the goal is to make sure your child is
taking in enough calories and nutrients.
To help with this, your child’s healthcare provider may recommend
Modified diets are developed especially for your child usually
with input of a dietician or nutritionist and can depend on
- age of your child
- area of the intestine affected by the disease
Modified diets can include
- low fiber, low residue diet
- lactose-free diet
- high calorie diet
Low fiber, low residue diet
When your child has active Pedi IBD, the ability of their intestine
to digest and absorb or take in foods is not as good as it
Fiber is a part food that is not digested in the human intestine
and is usually eliminated from the body in a bowel movement.
Eating foods high in fiber when your child’s disease is active
- increase diarrhea
- increase pain and discomfort with bowel movements
- increase bleeding
Avoiding foods with high fiber content such as
- fresh vegetables and fruit
- whole grains, cereals, nuts and popcorn
can help to decrease stools and help to ‘rest’ the intestines.
When Pedi IBD is active, changes to your child’s diet are
recommended mainly to help with any discomfort or unpleasant
symptoms your child may have.
A low fiber low residue diet may also be recommended in children
who have a narrowing or a stricture in the intestine from Crohn’s
disease, or when surgery is performed to remove part of the
intestine due to complications from Pedi IBD.
If your child’s doctor does recommend a low fiber low residue
diet, they may also recommend a multivitamin or vitamin supplements
in order to add nutrients normally found in fruits and vegetables.
Remember to always check with your child’s healthcare provider
before beginning a new diet.
Lactose free diet
Lactose is the carbohydrate portion of milk.
It can be difficult to tell the difference between lactose
intolerance and a milk allergy. A lactose breath test
can be performed to diagnose lactose intolerance, and your
child’s healthcare provider may order this test before making
any changes to your child’s diet.
Children with lactose intolerance, especially with disease
in the small intestine, sometimes benefit from a lactose-free
Symptoms of lactose intolerance include
- increased burping
- increased gas
- stomach pain
These symptoms can decrease or go away completely when milk
and dairy products including
- cheese, ice cream and yogurt
are removed from the diet.
Because milk and dairy products are very important sources
of nutrition for a growing child, your healthcare provider
may suggest switching to
- lactose-free milk
- or recommend your child take a lactase supplement when
eating milk products
Before taking dairy products out of your child’s diet, talk
with your healthcare provider about ways to do this a little
at a time.
A dietician or nutritionist can also make suggestions that
will help to lessen symptoms and keep up the amount of calcium
and vitamin D in your child’s diet.
In children who are allergic to milk proteins or have
fortified soy milk or fortified rice milk can be used instead
of regular milk.
Vitamin and Mineral Supplementation
Children’s bones continue to grow throughout childhood and
into early adulthood. For this reason, it is especially important
to make sure children get enough calcium in their diet during
the childhood years and puberty.
Too little calcium in the diet, or calcium deficiency
- can cause poor bone mineralization and bone growth
- may increase risk of osteoporosis or brittle bones
- lead to fractures
Including milk and dairy products in your child’s diet is
a good way to give them the calcium and vitamin D they need
for strong bones.
Your child’s healthcare provider may recommend a calcium supplement
if your child is unable to take in enough calcium from the
foods they eat.
Vitamin D supplements are not often recommended and usually
only if your child has a history of low vitamin D levels.
In most cases, a well balanced diet including dairy products
and regular exposure to sunlight is enough to maintain good
vitamin D levels.
Regular physical exercise also helps to make healthy bones
and can be encouraged if your child is able.
Many children with IBD have iron deficiency or not enough
iron in their blood. Iron deficiency can happen because of
- poor food intake
- poor absorption
- loss of iron because of blood in the stool
Iron deficiency can lead to anemia. Anemia can make your child
unusually tired and can make it difficult for them to participate
in everyday activities. Eating foods rich in iron may
help to correct this, such as
- red meats, beans, spinach and milk
Iron levels can be measured with a blood test and children
with low iron levels may be prescribed iron supplements by
their healthcare provider.
Vitamin B12 deficiency can happen in children with Crohn’s
disease in the terminal ileum where the small intestine connects
with the large intestine.
Children who have had surgery to remove this part of the intestine
can also develop a B12 deficiency, as vitamin B12 is absorbed
in the terminal ileum.
Levels of vitamin B12 can be measured by a blood test, and
children with low levels may be prescribed be vitamin B12 supplement
or injections by their healthcare provider.
Deficiencies or lack of other micronutrients like
and develop in children who have
- extensive disease in the small intestine
- large surgical resection
Nutritional supplementation may be prescribed when a child’s
Pedi IBD is very active. Supplementation may help manage
symptoms such as
- weight loss
- slow growth or lack of growth
- delay in puberty
- effects on bone health
- increased infections
In some cases, children with severe symptoms may benefit from
- semi-elemental, elemental or polymeric formulas
that can be used to increase calories and taken as a drink.
The taste of these can be a problem for some children. If
a child cannot drink the supplements they can be given through
- nasogastric (NG) tube
- gastrostomy tube
The NG tube can be placed on a nightly basis and removed during
the day to maintain normal activities. The gastrostomy tube
leads directly into the stomach and is placed by a pediatric
The goal of nutritional supplementation is to make sure that
the child is getting 100-150% of the calories recommended daily
for their age.
There are a number of research studies that show nutritional
therapy to be effective in
- bringing about disease remission
- reversing growth failure
Nutrition can also be given through a tube in a vein. This
is known as
- peripheral hyperalimentation
This kind of supplementation is given through a special intravenous
line (PICC line, central line) and is usually used only with
children who have had surgery or are hospitalized for long
Complementary nutritional therapies
Complementary nutritional therapies are used in addition to
medications prescribed for Pedi IBD by your child’s healthcare
Complementary therapies sometimes used by children with Pedi
- Omega-3 fatty acids
Probiotics are dietary supplements that contain bacteria
that may be beneficial. The commonly used probiotics are
- Culturelle® (Lactobacillus GG)
Probiotics may help to reduce intestinal inflammation by reducing
the overgrowth of harmful bacteria.
Probiotics may help to improve
- infectious diarrhea
(a condition that sometimes happens after surgery in patients
in with ulcerative colitis)
Probiotics may help to reduce food allergies and eczema. Some
children can complain of mild bloating and increased gas. Probiotics
are generally easy to take and are considered safe for children.
Probiotics in smaller amounts can be found in foods like
- yogurt, fermented milk and buttermilk, or
- juices that are specially enriched with active probiotics
It is not clear yet if the amounts of live bacteria in these
foods are enough to give any real benefit.
Omega-3 Fatty Acids
Omega-3 fatty acids have anti-inflammatory properties that
may help to reduce some symptoms of Pedi IBD. Omega-3 fatty acids are found in
- plant oils (flax seeds)
- fish oils (sardines, herring, mackerel, bluefin tuna, salmon)
and can also be taken as a supplement in pill or liquid form.
It is important to remember that there are no conclusive studies
that show a clear benefit in taking Omega-3 fatty acids, but
they are considered safe with no side effects.
At the present time the data currently available does not prove
benefit of complementary therapies in reducing the disease activity
of Pedi IBD.