the importance of a healthy diet for children with ibd

You hear it all the time. The importance of a healthy diet. Aphorisms like “An apple a day keeps the doctor away,” “You are what you eat,” and “Food is fuel” circulate like wildfire within popular culture. You know that a healthy diet is important, and you know the basics of what constitutes a healthy diet. You've seen MyPlate images online depicting healthy portions of proteins, grains, dairy, fruits, and vegetables. You know that you should try to incorporate these food groups into each meal you serve your child. You know that in a general sense, it is better to serve more single ingredient/unprocessed foods than processed foods. If your child is diagnosed with IBD, however, you may be wondering if any of this translates to how you should be feeding and nourishing your child. Do the basic principles of a healthy diet still apply to your diagnosed child's diet? How will preparing your child's meals differ post diagnosis? Should it? Is there one right way to feed your child? What does feeding your child with IBD look like practically? By feeding your child a certain way, did you cause your child's IBD diagnosis? This page will attempt to answer some of these questions, or at the very least, bring to light some information about the functional relationship between inflammatory bowel disease and diet.

Before we dive into the content, please note that this page is not intended to be a substitute for a professional medical opinion. For more detailed information regarding IBD or if you have questions pertaining to your child's individual treatment plan, please seek out the professional medical advice of your child's doctor. Additionally, while I am a registered nurse, I am not a registered dietician. This page is intended to be used to communicate generalized information regarding the role of diet in the life of a diagnosed IBD patient. I do not know your child's individualized diet needs. For more specific questions related to your child's unique diet and treatment plan, please refer to your child's doctor, as well as a registered dietician if/when appropriate. Now let's begin!

Does Diet Cause IBD?

A common misconception is that diet is the direct cause of IBD development. Please understand that your child was not diagnosed with IBD because you fed him or her a certain food or meal. Unfortunately, the exact cause of IBD is unknown. We do know, however, that the disease is a result of immune system dysregulation. In a patient with IBD, the individual's immune system develops an overactive, inappropriate immune response to the body's own GI tract. The most widely believed theory is that IBD develops after continued exposure to environmental triggers. These exposures spark the inappropriate, uncontrolled immune response in a genetically prone individual. Some of the different environmental triggers that have been explored are infection, exposure to smoke, medication use, pollution, climate change, hygiene, and diet. While diet is not the direct cause of IBD, there are some studies that seem to suggest that diets containing a high amount of fiber, particularly from fruits, may lower the risk of developing Crohn's disease, but not ulcerative colitis. There is definitely a need for more research on the relationship between diet and IBD, but it is important to remember that although there may be a small association between diet and IBD, diet is not the cause of diagnosis. There are several factors that lead to the diagnosis of IBD.

Why is Diet So Important for an IBD Patient?

As mentioned earlier, a healthy diet is important for everyone, but it is particularly crucial for children with IBD. Research has shown that a well-balanced diet can contribute to achieving and maintaining remission, reducing IBD symptoms, and improving overall nutritional status. Additionally, diet can play a role in improving immune function and nutrient absorption to better support growth and development.

What Should My Child Eat After Diagnosis?

The best piece of advice I can give you is to work closely with your child's doctor and/or an IBD-focused registered dietician to assist you in developing a personalized diet plan for your child. This plan would be individualized to your child's specific nutritional needs, factoring in diagnosis (i.e. Crohn's disease versus ulcerative colitis), status of disease (active or in remission), location and extent of disease, and any current symptoms your child is experiencing. Please note that there is not one single eating plan that works well for every individual diagnosed with IBD. There is not a magic formula or a magic diet for IBD. Every IBD patient has unique nutritional needs, and it is recommended that you work closely with your child's healthcare professionals to ensure that your child is receiving individualized nutritional care.

That being said, here is a bulleted list of general tips for feeding your child with IBD. These tips are meant to give you a birds-eye view of the role of diet in regards to IBD. They are applicable to a general audience, but you should always follow the advice of your child's doctor or registered dietician for a more specific nutritional plan pertaining to your child. This is especially true if you child is placed on a specialized diet (e.g. low FODMAP diet, Crohn's disease exclusive diet, anti-inflammatory diet, etc.).

Minimize trigger foods:

Trigger foods are simply foods that cause your child to experience discomfort. Trigger foods do not necessarily cause inflammation in your child's GI tract, but they can cause some pretty unpleasant symptoms. Every IBD patient will have different trigger foods.

Common trigger foods include:

Foods high in insoluble fiber (bran, nuts, sunflower seeds, apple skins, etc.)

Foods high in fiber (cabbage, broccoli, beans, cauliflower, etc.)

Foods high in lactose (cow's milk, ice cream, etc.)

Foods high in sugar (cookies, pastries, maple syrup, etc.)

Fried foods/high fat foods (butter, fried chicken, etc.)

Spicy foods

Caffeinated beverages

Minimize foods that can increase inflammation:

Certain foods, such as red meats, have been linked to increasing overall inflammation when consumed frequently over a long period of time. Moderation is key!

Increase foods linked to decreased inflammation:

Focus on increasing foods that are linked to decreasing inflammation, including fruits and vegetables, foods high in omega 3 fatty acids (fatty fish, chia seeds, flaxseed, etc.)

When your child is in flare:

If your child is in flare, focus on increasing fluids and increasing protein (lean meats, beans, yogurt, chia seeds, etc.). If your child's appetite has decreased while in flare, focus on nutrient-dense snacks offered frequently throughout the day, rather than big meals.

For example, you may be able to offer your child a smoothie packed with fruits, veggies, and chia seeds. Another snack option could be a banana with a spoonful of peanut butter. Over time, you will find what works best for you and your child.

When your child is in remission:

When your child is in remission, focus on offering a wide variety of foods to ensure that your child is receiving a well-balanced diet. You should still be mindful of trigger foods, as well as foods that tend to cause inflammation over a longer period of time.

Practical Tips

You may be wondering how the above information translates into real-life scenarios. How can you apply what you just read in a practical way to meet the nutritional needs of your child? Here are some tips to help you deconstruct the above information and integrate it into your child's day-to-day life.

Keep a food log/diary. Keeping a tangible record of what your child eats throughout the day, as well as any symptoms your child is experiencing, is a very effective strategy to identity trigger foods and track the nutritional status of your child. In keeping a food journal, you may notice that your child actually consumes a fraction of the amount of recommended vegetables throughout the day. Or you may identity that honey, a very sugary food, is one of your child's main trigger foods. A food log is an especially helpful tool to your child's doctor or registered dietician. He or she can review the log and identity and discuss any nutritional gaps that may be missing from your child's diet. A registered dietician can also use the information recorded in a food log to help curate your child's unique diet plan.

Prepare meals in advance. It may be helpful to prepare meals in advance. You may even consider freezing some meals. Planning/preparing meals in advance provides you with a greater chance of sticking to your child's diet plan and recording foods/symptoms in your child's food diary.

Keep your kitchen well stocked. Try to keep your kitchen well stocked with snacks and ingredients for meals you know will not be triggering for your child/lead to inflammation.

Plan for those nights. You know those nights. I'm talking about the nights when you are too tired to cook dinner or you run out of freezer/prepared meals. Have a few meal ideas in your head that you can fall back on in a pinch. Ideally, these meals are quick, easy, and adhere to your child's diet restrictions. Keep the ingredients for these meals well stocked in your home for these types of nights.

Plan for meals outside of the home. Look up menus to restaurants ahead of time if possible! If you are gathering at someone else's home, you can always bring your own meal for your child, or discuss the meal ingredients with the host of the gathering if you are comfortable.

Other General Tips:

Make sure your child is well hydrated. Offer plenty of fluids! Your child's urine should be pale yellow and clear, not dark yellow/amber.

Ask your child's doctor about consulting with a registered dietician.

Consult your child's doctor for vitamin/supplement recommendations.

Give yourself some grace. Preparing IBD-friendly meals is no easy feat. Remember, it is more important to focus on your child's overall diet/eating patterns, rather than one specific snack, meal, or day.

As your child ages, be mindful of their behaviors towards food and be on the lookout for disordered eating or restrictive eating. Please seek help from a professional if necessary.

Malnutrition

Both Crohn's disease and ulcerative colitis impact your body's ability to properly absorb nutrients from ingested food, which means there is a greater risk of malnourishment. Be mindful of signs and symptoms of malnutrition in your child. Should you observe any signs of malnutrition, you should contact your child's doctor immediately to prevent long-term complications, such as delayed growth, stricture, and decreased bone density. You can discuss any potential nutritional gaps with your child's doctor or a registered dietician. Some of the more noticeable signs of malnutrition include:

Fatigue and/or low energy

Decreased muscle mass

Weight loss and/or lack of growth in a child

Weakness

Final Thoughts

Maintaining a healthy diet is important for children with IBD, as it can help reduce IBD symptoms, improve nutrient absorption and immune function, achieve and maintain remission, and support overall health and development. I hope the information on this page was useful to you as you navigate your child's IBD journey in relation to their diet. Please note that this page does not address nutritional support therapy (e.g. enteral or parenteral nutrition) or specific diet plans for IBD, such as an anti-inflammatory diet, an autoimmune protocol diet, or a low FODMAP diet. There are several different types of diet plans that can be implemented for IBD patients, and a registered dietician may suggest a specific one based on your child's disease process, location, and symptoms. If you would like more help or have any questions pertaining to diet, you can feel free to reach out to me using my email address linked below. Please know that there are options for support available as well. Being a parent of a child with IBD can be challenging! IBD Connect offers a virtual caregiver support group that meets one time monthly. We also have an in-person family support group, a virtual family support group, and a virtual young adult support group as available options for support. If you would like more information about these groups, click the link at the bottom of this page. Stay strong IBD Warrior parents!

Lewis, Sharon et al., Medical-Surgical Nursing: Assessment and Management of Clinical Problems (St. Louis, Missouri: Elsevier, 2017), 944.

Sudabeh Alatab et al., The Global, Regional, and National Burden of Inflammatory Bowel Disease in 195 Countries and Territories, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017

Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn's disease and ulcerative colitis.

Bibliography

Alatab, Sudabeh, Sadaf G Sepanlou, Kevin Ikuta, Homayoon Vahedi, Catherine Bisignano, Saeid Safiri, Anahita Sadeghi, et al. “The Global, Regional, and National Burden of Inflammatory Bowel Disease in 195 Countries and Territories, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017.” The Lancet Gastroenterology & Hepatology 5, no. 1 (2020): 17–30. .

Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of

dietary fiber and risk of Crohn's disease and ulcerative colitis. Gastroenterology. .

Lewis, Sharon Mantik, Linda Bucher, Margaret McLean Heitkemper, and Mariann M. Harding. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. St. Louis (Miss.): Elsevier, 2017.