Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that affects the inner lining of the colon and rectum, causing inflammation and ulceration. While most cases develop during the mid-teens or adulthood, children can also be affected. Managing UC in children often involves dietary adjustments to alleviate symptoms, promote healing, and ensure adequate nutrition. Optimizing nutrition is critical to promote growth and development of all patients with ulcerative colitis (UC). There is no special diet for UC. It is important for children not to exclude food groups for fear of intolerance, without first consulting a dietitian.
Understanding Ulcerative Colitis in Children
In children, just as in adults, UC causes ulcers within the colon - the lower part of the digestive tract. UC damages the intestinal barrier, which typically keeps harmful toxins inside the gut while allowing fluids and nutrients to pass from the gut into the blood. This inflammation may result in symptoms such as abdominal pain, diarrhea, bloody stool and feelings of urgency to have a bowel movement. As these symptoms persist, they can lead to fatigue, weight loss, anemia, and loss of appetite. One of the most common findings in a child with UC is bloody diarrhea.
Because UC can reduce appetite, it’s sometimes difficult for kids with this condition to get proper nutrition. When your child is having symptoms, encourage them to eat as much as they are comfortable with. If your child’s appetite is low, talk with their doctor about whether supplementing with a multivitamin or a high calorie nutrition aid, such as a shake, drink, or bar, may be a good choice, especially during a flare.
General Dietary Guidelines for Children with UC
There’s no one perfect diet for kids with pediatric ulcerative colitis, but certain food choices and eating tips may help. There is no evidence that certain foods directly affect the inflammation of the intestine, causing it to worsen or improve. However we do know that certain “trigger” foods can aggravate symptoms, leading to worsened abdominal pain and diarrhea.
As a general guide, the Crohn’s and Colitis Foundation (CCF) recommends that children with IBD consume a healthy diet that contains a variety of foods from all major food groups.
Read also: Dietary Guidelines for Pediatric Pancreatitis
A healthy diet includes foods from all food groups. A balanced diet that is rich in nutrients can boost the diversity of the gut microbiome and help manage ulcerative colitis (UC) in children. Avoiding highly processed foods and refined sugars will also benefit someone with UC. According to a 2019 research review, the food a person eats can affect their gut microbiome. The gut microbiome is the ecosystem of microbes that live in the gut and likely play a key role in intestinal barrier function. A healthy diet that is rich in nutrients can boost the diversity of the gut microbiome, which in turn may improve intestinal barrier function. In contrast, a diet that is high in highly processed foods, refined sugar, and saturated fats can cause an imbalance in the gut microbiome, which may impair intestinal barrier function. This can lead to inadequate nutrient absorption, nutritional deficiencies, and impaired growth in children.
The CCF recommends that children with IBD consume a diet that includes:
- Fruits and vegetables: These provide fiber and essential nutrients such as vitamin C, potassium, and folate.
- Grains: These are high in fiber and energy and contain nutrients such as B vitamins, folate, and iron. Consider whole wheat bread, rice, or pasta. And for a vegetable side, cooked carrots or zucchini can be easy on the gut.
- Protein-rich foods: Protein options may include meats and plant-based foods such as soy, beans, nuts, and seeds. Protein is essential for growth and tissue repair. For protein, try plain chicken or a white fish. Choose lean proteins such as poultry, eggs, fish, or beans.
- Dairy products: Dairy is an excellent source of calcium and vitamin D, which are essential for healthy bones and teeth. Include dairy in moderation to meet daily recommendations for calcium, choosing lactose- free products if this improves tolerance.
- Foods high in healthy fats and oils: These foods are calorie-rich and help the body absorb fat-soluble nutrients. Examples include fish and fish oils, avocados, and nuts.
Foods to Limit or Avoid
The CCF recommends that children with IBD avoid or limit certain foods, especially during a flare.
During a flare, common trigger foods can be high fiber foods such as raw fruits and vegetables or whole grains. Cooked fruits and vegetables as well as white grain products may be better tolerated temporarily until the flare resolves. Additionally, high fat, greasy, and fried foods can worsen symptoms during a flare; as well as sweets including sweetened beverages, desserts, and juices.
Foods to limit may include:
Read also: The Mediterranean Diet Guide
- Greasy or fried foods
- Milk and dairy products if the child is lactose intolerant: If dairy worsens IBD symptoms, try replacing with lactose-free dairy products or milk substitutes that are fortified with calcium and Vitamin D.
- Certain high fiber foods:
- Nuts
- Seeds
- Beans
- Popcorn
- Wheat bran
- Green leafy vegetables
- Raw fruits and vegetables
The CCF recommends that children with IBD avoid or limit certain foods during an IBD flare, such as:
- Any foods that have worsened their symptoms in the past
- Caffeinated beverages, as caffeine can stimulate the bowel and cause diarrhea
Specific Dietary Approaches
Different kids with UC may respond well to different types of diets.
Specific Carbohydrate Diet (SCD)
Some children may do well on the Specific Carbohydrate Diet (SCD). Developed in the 1920s as an eating plan for people with celiac disease, this diet has been shown to induce remission of active inflammation in some people.
Following the SCD involves cutting out grains and grain-based foods, milk, most sugars, some legumes, tubers, and many foods with additives. Acceptable foods include minimally processed meats and beans, low-lactose dairy, fruits, vegetables, most nuts, and honey.
Low FODMAP Diet
Other children with UC may benefit from a low FODMAP diet. A small 2020 study found that people who followed this diet experienced improvements in several UC symptoms after just 4 weeks. However, the study participants were adults, not children.
Read also: The Hoxsey Diet
A low FODMAP diet limits the consumption of foods high in a certain type of short-chain carbohydrates. Foods that don’t make the cut: wheat, beans, garlic, onions, milk; certain fruits, such as apples, mangoes, and watermelon; and certain vegetables, such as asparagus and leeks.
BRAT Diet
“BRAT” stands for “bananas, rice, applesauce, and toast.” Over the years, healthcare professionals have sometimes recommended these foods to minimize digestive problems in children. If your child tolerates these foods during a flare, they’re fine to eat, but you can certainly explore other options as well.
Exclusive Enteral Nutrition (EEN)
Exclusive enteral nutrition (EEN) is the original nutrition-based intervention for managing patients living with mild-to-moderate Crohn’s disease. Exclusive enteral nutrition (EEN) is the most important nutritional intervention in pediatric IBD, consisting of a complete liquid formula as the unique source of daily energy requirement for a period of 6-8 weeks. Formula constitutes most of the calories consumed as either primary or adjunctive therapy, typically for eight to 12 weeks. This approach has been utilized in Europe and Canada for decades with increased utilization in the United States over the past decade. EEN can be highly effective as an induction therapy, the first phase of therapy to quiet down inflammation, without the side effects associated with medications like steroids. It can be effective in patients who cannot tolerate solid foods due to complications related to their Crohn’s disease, like strictures in the small intestine, as optimization prior to upcoming IBD-related surgeries, or for effective nutritional repletion in patients who are malnourished due to their IBD.
Practical Tips for Caregivers
The CCF provides tips for caregivers, which focus on promoting a healthy diet and dietary habits in children with IBD:
- Involve the child in meal planning and preparation so they can learn to prepare healthy meals on their own.
- Bring the child grocery shopping so they can learn to read food labels and check for ingredients that may trigger their UC.
- Help the child keep a food journal so that they can identify potential trigger foods and try to avoid them in the future. Teens might even use an app such as My IBD Care to track food choices and symptoms.
- Request adjustments and accommodations at school, such as permission for the child to eat snacks and drink liquids throughout the day.
Managing Stress
Your child may feel worried about having a bowel accident, embarrassed, or even feel sad or depressed. They may find it difficult to participate in activities at school. You can support your child and help them understand how to live with the disease.
These tips can help you manage your child's ulcerative colitis:
- Try to talk openly with your child. Answer their questions about their condition.
- Help your child be active. Talk with your child's provider about exercises and activities that they can do.
- Simple things such as doing yoga or tai chi, listening to music, reading, meditation, or soaking in a warm bath can relax your child and help reduce stress.
- Be alert if your child is losing interest in school, friends, and activities. If you think your child may be depressed, talk with a mental health counselor. You may want to join a support group to help you and your child manage the disease. Crohn's & Colitis Foundation of America (CCFA) is one of such groups.
The Role of Supplements, Vitamins, and Minerals
Ask the provider about extra vitamins and minerals your child may need, including:
- Iron supplements (if they are anemic)
- Nutrition supplements
- Calcium and vitamin D supplements to help keep their bones strong
It is usually recommended that your child take a multivitamin with iron. Children with IBD are at risk for osteoporosis (thin, weak bones) especially if they are on high doses of corticosteroids for a long time. Steroids interfere with the body’s ability to absorb calcium. recommended amounts of calcium and Vitamin D for strong bones and teeth. Talk with a dietitian to make sure your child is getting proper nutrition.
Working with Healthcare Professionals
A parent or caregiver should consult a gastrointestinal specialist or pediatric dietitian before starting a child on any restrictive diet. A visit to a pediatric dietitian is an excellent place to start for customized advice about the right diet for kids with UC. Ask the child’s doctor for a referral to a registered dietitian who can help with meal planning, or use the CCF’s online directory to find a dietitian in the local area. Your child's ongoing care will be based on their needs.
Medications
Your child's provider may give them some medicines to help relieve their symptoms. Based on how severe their ulcerative colitis is and how they respond to treatment, they may need to take one or more of these medicines:
- Anti-diarrhea drugs can help when they have bad diarrhea. You can buy loperamide (Imodium) without a prescription. Always talk to their provider before using these drugs.
- Fiber supplements may help their symptoms. You can buy psyllium powder (Metamucil) or methylcellulose (Citrucel) without a prescription.
- Always talk to your child's provider before using any laxative medicines.
- You may use acetaminophen for mild pain. Drugs such as aspirin, ibuprofen, or naproxen may make their symptoms worse. Talk to their provider before taking these medicines.
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