Increasing numbers of children are being diagnosed with Crohn’s disease or ulcerative colitis—and nutritional therapy is important in managing these diseases. A dietitian explains how extremely restrictive diets can have both short-term and long-term consequences for young children living with IBD.
If there’s a common theme among parents of a child with inflammatory bowel disease (IBD), it’s the uncertainty they live with on a daily basis. On the bad days, some describe it as an “emotional rollercoaster.” But on the good days, something brighter shines through: a special ability to delight in moments of normalcy with their child—moments like running through the park and going down the slide; eating popsicles together on the deck. A growing problem
More and more parents are finding themselves in this group, as the incidence of childhood IBD continues to rise—both globally and within Canada. While childhood-onset IBD was a rare diagnosis two decades ago, it has seen a sharp increase in recent years and continues to rise in children under the age of five.
The inflammatory bowel diseases comprise Crohn’s disease and ulcerative colitis—disorders that involve inflammation of the inner lining of the digestive tract. Outward symptoms include severe diarrhea and abdominal pain as well as fatigue and weight loss; sometimes children also experience rectal bleeding. IBD diagnosis is made by a gastroenterologist based on the combined information from gastrointestinal (GI) endoscopy and other tests.
The impact of Crohn’s disease and ulcerative colitis on children’s lives varies, as the diseases bring intervals with no symptoms (called remission), alternating with intervals of active disease (called flares). During times when the disease is active, children with IBD tend to get less physical activity and have poorer psychological functioning.
Dealing with such a complex disease while growing up is no easy feat—over the years, youth with IBD experience more problems in how they function among peers, within their family, and at school.
Focusing on nutrition
Diet and nutrition must take special priority for kids with IBD, according to a recent European medical expert consensus. Many families find their child’s symptoms are triggered by particular foods—but avoidance of foods or entire food groups may have consequences.
“IBD management is particularly complex in children because the disease involves a growing individual,” says Natasha Haskey, a registered dietitian with 20 years’ experience working with children and adults diagnosed with IBD. “Lack of weight gain, poor growth, delayed puberty, reduced food intake, and malabsorption are all frequently seen in [these] children, and places them at risk for malnutrition.”
In some cases, and for a specific short period, medical professionals oversee exclusive enteral nutrition (EEN) therapy—that is, delivering a liquid diet formula, often via tube—to induce remission in pediatric Crohn’s disease. But in children who don’t receive EEN, all too commonly, extremely restrictive diets are employed to manage symptoms.
But strict elimination of foods can be a double-edged sword for these children, says Haskey: “Use of elimination diets in children with IBD is not recommended.” In essence, these extreme diets can lead to periods of time when young bodies miss out on important nutrients, potentially compounding their health issues.
This is where the need for an IBD-experienced nutritional professional becomes important—someone who can advise on how to work around the trigger food or foods while still meeting the child’s overall nutritional needs.
“Dietary supplements may be required to meet nutrition requirements,” Haskey says. “However, before starting a supplement, it’s important to have a discussion with your health care team. Each child/adolescent will have unique nutritional needs.”
With new microbiome research showing that communities of bacteria and fungi in the digestive tract contribute to IBD pathogenesis, probiotics have received particular attention. And while a body of literature shows probiotics are effective for a variety of gastrointestinal symptoms in both children and adults, they can be a whole different ballgame for a child with IBD.
Haskey says, “Parents should speak with their child’s doctor before administering [probiotics] to their child.” She notes that some studies of probiotics in maintaining the remission of ulcerative colitis in pediatrics have shown promise, while “probiotics should not be used in children living with Crohn’s disease.”
In addition to efficacy of the probiotic, safety should be a priority, as children with IBD may be immunocompromised. Suitable probiotics are those produced by a company complying with all good manufacturing standards.
Set up for success
Nutritional factors are important for children living with IBD—and in the best-case scenario, parents and health professionals work together to help kids get what they need for health and success.
Symptoms can overlap in Crohn’s disease, ulcerative colitis, and irritable bowel syndrome (IBS). What’s the difference between these three conditions?
|IBD: Crohn’s disease||• involves any part of the digestive tract
• “patches” of inflammation occur
• inflammation can go deeper into the layers of the GI tract
|IBD: ulcerative colitis||• involves only the colon and rectum
• entire lining of the GI tract in these regions is inflamed
• inflammation is restricted to the innermost lining of the GI tract
|IBS||• based on reported symptoms alone
• no physical cause for the symptoms can be identified
Supplements for IBD
- IBD is a chronic disease that requires the care of a medical team that includes a gastroenterologist. Sometimes, adjunctive treatments for these children include supplements such as
- zinc (to correct possible deficiencies)
- vitamin D (to correct possible deficiencies)
- fish oil (omega-3 fatty acids)
While the most suitable diet for a child with IBD will be personalized, Haskey says the scientific research generally supports
- increased fibre intake, particularly from soluble fibre sources (such as oats, beans, peas, lentils, barley)
- increased fruit and vegetable intake (aim for at least two servings per meal)
- limited intake of red meat (pork, beef, lamb; aim for less than two servings per week)
- avoidance of high-sugar foods and soft drinks
- avoidance of trans fats
- avoidance of highly processed foods and beverages that contain large amounts of emulsifiers (for example, carboxymethyl cellulose [CMC], carrageenan, polysorbate 60 or 80, or xanthan gum)