Synopsis
Recognise paediatric Crohn disease and ulcerative colitis before growth failure advances, stage intestinal and extra-intestinal disease and coordinate nutrition, medicines, surgery and developmental monitoring through specialist care.
- Suspect IBD with persistent blood or nocturnal stool, abdominal pain, weight or height faltering, pubertal delay, perianal disease, mouth ulcers or extra-intestinal inflammation.
- First-line tests include FBC, CRP or ESR, albumin, renal and liver profiles, ferritin and stool microbiology; faecal calprotectin supports intestinal inflammation but does not establish diagnosis.
- Refer suspected paediatric IBD urgently to specialist gastroenterology; diagnosis and classification use ileocolonoscopy and upper endoscopy with biopsies plus small-bowel imaging where appropriate.
- Assess growth, puberty and nutrition at diagnosis and every review; paediatric disease cannot be monitored by stool symptoms alone.
- For Crohn disease, NICE allows enteral nutrition as an alternative to systemic corticosteroid induction when growth or steroid effects are concerning; specialist paediatric practice often uses exclusive formula for 6 to 8 weeks.
- For mild to moderate ulcerative colitis, aminosalicylate treatment is selected by extent; topical treatment is first line for proctitis and left-sided disease, with oral therapy added or used for extensive disease.
- Acute severe ulcerative colitis requires admission, intravenous corticosteroids and gastroenterology-surgical collaboration; little improvement within 72 hours prompts rescue therapy or surgery decisions.
- Immunomodulators and biologics require pre-treatment infection and vaccine review, exact laboratory monitoring and a named clinician to act on abnormalities.
- Support school access, mental health, adherence, fertility discussion and planned transition to adult care.
Key red flags
Persistent blood in stool, nocturnal diarrhoea, weight loss, falling height velocity or delayed puberty requires urgent paediatric assessment.
Severe abdominal pain, guarding, distension, bilious vomiting or absent bowel sounds raises obstruction, abscess, toxic megacolon or perforation.
Perianal fistula, abscess, skin tags or poor wound healing strongly suggests Crohn disease and needs expert examination.
Fever, tachycardia, more than eight stools daily, low haemoglobin or albumin and CRP above 45 mg/L increases likelihood of surgery in acute severe colitis.
Immunosuppressed children with fever, breathlessness, vesicular rash or exposure to serious infection need urgent treatment review.
Medication planning must include vaccination, tuberculosis and viral screening where relevant, fertility, malignancy and laboratory safety.
Investigation priorities
Detect anaemia, inflammation, hypoalbuminaemia, organ involvement and treatment baseline abnormalities.
Management branches
Blood, nocturnal stool, growth failure, anaemia or perianal disease persists.
- Assess severity, hydration and abdominal or perianal complication and admit if unstable.
- Obtain inflammatory, nutritional and stool tests without delaying specialist referral.
- Continue adequate nutrition and avoid empirical restrictive diets that impair growth.