A child’s overall health is often reflected through growth. In the absence of appropriate height or weight gain, a careful assessment is mandatory to rule out underlying disease conditions. Crohn’s disease and ulcerative colitis, which come under Inflammatory Bowel Disease (IBD), are among the conditions that can significantly contribute to impaired growth in children and adolescents.
Understanding IBD
The gastrointestinal tract comprises of the oesophagus, stomach, small intestine, and large intestine. Chronic inflammation affecting any part of this gastrointestinal lining is called IBD. It commonly presents with abdominal pain, loose stools sometimes mixed with blood or mucus, anorexia, vomiting, and fatigue. During the crucial growth phases of childhood and adolescence, IBD can affect both physical growth and mental development.
Impact on growth
The gut’s chronic inflammation affects the body’s ability to absorb essential proteins, vitamins, and minerals. Muscle growth and bone density rely heavily on these vital nutrients. Even with a balanced diet, children with IBD may still experience undernutrition. Poor absorption, diarrhoeal losses, reduced intake, and ongoing inflammation together contribute to malnutrition. In addition, the body diverts essential energy away from normal growth and development to manage systemic inflammation.
IBD also produces inflammatory molecules that suppress the functioning of hormones such as growth hormone and sex hormones, thereby delaying growth and puberty. In some children with Crohn’s disease, impaired growth and delayed puberty may even appear before gastrointestinal symptoms become evident.
Loss of appetite and fear of worsening symptoms after eating often cause children with IBD to avoid food, leading to significant dietary restrictions. Reduced calorie intake combined with increased metabolic demand leaves fewer calories available for the body to utilise for growth and development.
A child’s progress is best assessed through weight, height, and developmental milestones. Doctors therefore recommend careful and regular monitoring of growth charts and puberty in children with IBD. It is also important to screen and test for IBD in children with unexplained poor growth.
Holistic management
Managing IBD is not simply about controlling gastrointestinal symptoms but requires a holistic approach involving a multidisciplinary team. The team, usually headed by a pediatric gastroenterologist, may also include a dietician and other allied specialities depending on extra-gastrointestinal symptoms. Treatment primarily aims to reduce inflammation completely and achieve sustained deep remission through long-term biological therapy, immunosuppressants, and anti-inflammatory medications.
Crohn’s disease, often considered the more severe form of IBD, can be managed to a considerable extent through exclusive enteral nutrition and focused nutritional therapies that help control the disease while improving nutritional status. Equal attention must also be given to supporting bone health and correcting macro- and micronutrient deficiencies. Iron, calcium, and vitamin supplementation, along with diet and anti-inflammatory treatment, play an important role in this process.
Children dealing with prolonged illness may gradually experience social withdrawal, anxiety, and stress, all of which affect their overall wellbeing. Proper counselling, continuous emotional support, and assessment of psychological impact are therefore just as important as medications in IBD management.
Increased awareness, early diagnosis, and advances in treatment have significantly improved the lives of children affected by IBD. As mentioned earlier, subtle signs such as growth failure should raise suspicion for IBD even when gastrointestinal symptoms are absent or mild. Delayed diagnosis can result in complications such as fistulae, strictures, and perforation, which are often difficult to treat.
IBD is not merely a gastrointestinal illness but a systemic disease that can affect a child’s overall growth and development.
Early diagnosis, timely treatment, close monitoring, and multidisciplinary care that includes nutritional and emotional support are essential to help children with IBD achieve their full growth and developmental potential.
(Dr. D. Venkata Umesh Reddy, Consultant Pediatric Gastroenterologist and Hepatologist, Ankura Hospital, umeshreddyd@gmail.com)
Published – May 31, 2026 01:00 pm IST