How IBD Affects Growth in Kids and Teens

About a quarter of all patients with inflammatory bowel disease (IBD) are diagnosed as children. Kids with IBD face a host of complications. including slowed growth. Normal growth in kids with IBD can be adversely affected by such factors as intestinal inflammation, malnutrition, reduced calorie intake, and medication side effects.

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One major concern is that the bone growth in kids with IBD may lag behind that of children of the same age who do not have IBD. To learn more about how one's height as an adult may be affected by IBD in childhood, I turned to UpToDate—a trusted electronic reference used by many physicians and patients looking for in-depth medical information.

"Because children with pubertal delay usually have delayed bone age, some catch-up growth is possible after the onset of puberty. However, growth during puberty may also be compromised in those with prolonged inflammatory disease, malnutrition, or corticosteroid therapy, so adult height may be affected."

Several factors may negatively affect the eventual adult height of a child who has IBD, including long-standing, active disease; poor nutrition; and taking steroid drugs such as prednisone to reduce inflammation. Crohn's disease, in particular, is associated with more growth problems in children than is ulcerative colitis, but all forms of IBD can have negative effects on growth.

Proper Nutrition and Remission

In order to combat these factors, care must be taken to ensure that children with IBD receive proper nutrition and get their disease under control as quickly as possible. Achieving remission during puberty is an important part of helping ensure that bone growth and growth spurts occur at a more normal rate. 

One treatment that is not typically used in adults but is used in children is exclusive enteral nutrition (EEN). In EEN, most nutrients (up to 90% of necessary calories) are taken in through special nutritional drinks and/or a feeding tube if needed. This treatment method has been found to be as effective as steroids in inducing remission and has also been shown to promote mucosal healing in some patients.

Altering Treatment Plans

Using medications other than steroids whenever possible may help preserve bone growth in children with IBD. When steroids are needed, taking them every other day (instead of every day) and reducing the dosage as quickly as safely possible are also used to help preserve bone health in children. (If your child is currently on steroids, do not change their dose without talking to their physician.) It is well-known steroids adversely affect bones, and can even lead to osteoporosis.

Minimizing the effects IBD has on a child's growth can ensure that children who have IBD have the best chance of achieving a normal growth rate and adult height. There's a trend toward treating IBD in children more aggressively than in adults in order to achieve remission quickly and to preserve normal bone growth.

Specialists may recommend treating the IBD with a "top-down" approach instead of a "step-up" approach. What this means is that a pediatric gastroenterologist might recommend a biologic (which may be given by infusion or injection or a combination of both) as a first treatment, rather than trying older oral or topical medications and waiting to see what happens. For those children that are diagnosed before puberty, this approach may help achieve a more typical growth pattern prior to adolescence.

A Word From Verywell

In some cases, poor growth might be the first indicator that IBD is a problem for a child. For children with IBD, growth might not keep up with what's typical, and growth percentages might actually decrease. In that case, steps need to be taken to get the IBD under control and to bring growth back up to where it should be.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of paediatric ulcerative colitis, part 1: ambulatory care-an evidence-based guideline from european crohn's and colitis organization and european society of paediatric gastroenterology, hepatology and nutrition [published correction appears in J Pediatr Gastroenterol Nutr. 2020 Dec;71(6):794]. J Pediatr Gastroenterol Nutr. 2018;67(2):257-291. doi:10.1097/MPG.0000000000002035

  5. Briot K, Roux C. Glucocorticoid-induced osteoporosisRMD Open. 2015;1(1):e000014. Published 2015 Apr 8. doi:10.1136/rmdopen-2014-000014

  6. Gasparetto M, Guariso G. Crohn's disease and growth deficiency in children and adolescents. World J Gastroenterol. 2014;20(37):13219-13233. doi:10.3748/wjg.v20.i37.13219

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.