Introduction 

More and more children around the world are being diagnosed with Crohn’s disease, a condition that disrupts the body’s digestive system.¹ This lifelong illness falls under the category of inflammatory bowel diseases (IBD) and is immunological.¹ The symptoms of Crohn’s disease include intestinal inflammation resulting in stomach pain, diarrhoea, fatigue, and in the unique case of paediatric Crohn’s disease, delayed reproductive development, potentially disrupting children’s body image, mental health, and overall development.³ While Crohn’s disease can occur at any age, paediatric-onset is increasingly recognised, with a significant proportion affecting children before they reach age 10, and in some cases even in infancy.⁴ Diagnosis and management of Crohn’s disease in adolescence is of increasing importance to address the staggering statistic that children make up a quarter of the overall distribution of IBD.⁵ As there is no cure for Crohn’s disease, proper nutritional management has the potential to improve symptoms and the overall quality of life for a young person youth affected by Crohn’s disease.³ This article explores evidence-based nutritional management strategies for paediatric Crohn’s disease. 

Understanding Crohn’s 

The exact origination and development of Crohn’s disease is not yet fully understood. What is clear, however, is that the sharp rise in cases in recent decades suggests that environmental and lifestyle factors play a major role, in addition to genetic predisposition.⁶ Understanding Crohn’s disease requires familiarity with the gut microbiome, that is, the composition of bacteria living in the digestive tract that aid in food digestion and relying on the consumption of food and nutrients.⁷ Imbalances in the gut microbiome are increasingly linked to Crohn’s disease, highlighting how dietary choices and microbial health can interact to improve or worsen Crohn’s disease.⁶

How can Nutritional Management Help? 

Careful nutrition is an important aspect of growth and development for all children, but for children with Crohn’s disease it becomes a key part of treatment. Crohn’s causes inflammation in the intestines, which can damage the lining, reducing the uptake of nutrients from food, leading to malnutrition or micronutrient deficiencies.⁸ If not managed, this can disrupt overall development and their ability to thrive, learn, and participate fully in daily activities such as school and sports. In severe cases, malnourishment causes refeeding syndrome, resulting in impaired breathing, seizures, and abnormal heart rhythm. 

Medication is available for the management of Crohn’s disease symptoms, but this is not always the best treatment option. Importantly, nutritional management reduces reliance on medications, helping prevent some of their long-term side effects, such as increased risk of diabetes and bone thinning.⁸ In addition to dietary choices and micronutrient supplementation, there are two widely recognised approaches to nutrition therapy for Crohn’s disease: exclusive enteral nutrition (EEN) and partial enteral nutrition (PEN).⁹

Exclusive Enteral Nutrition

The term enteral nutrition refers to supply of nutrients to the digestive system, either by drinking a prescribed formula or through a feeding tube.¹⁰ In relieving Crohn’s disease, this approach can be used in place of steroids, and is usually guided by a registered dietician.⁹ Exclusive enteral nutrition (EEN), sometimes called “total” enteral nutrition (TEN) involves100% of a child’s nutrition coming from a special liquid formula for a period, usually 6-8 weeks, during which no other food is allowed.¹¹

Like any treatment, there are both benefits and challenges to EEN. While EEN limits a child’s exposure to food and some children find it difficult to give up solid foods, it is important to remember that the treatment period is not forever! Some may have some short-term side effects such as stomach pain and vomiting. The benefits, however, far outweigh the costs and include higher rates of remission, improved muscle development, weight restoration and better overall nutrition.¹¹ In fact, in paediatric Crohn’s disease, clinical studies show that 70-90% of children achieve remission after completing EEN therapy.¹² By reducing inflammation and giving the intestinal lining a chance to heal, EEN supports not just symptom relief but also long term growth and development. 

Partial Enteral Nutrition and Maintenance 

While EEN is very effective, it is understood that it can be a challenge for children and families to sustain a formula-only diet for several weeks. This is where partial enteral nutrition (PEN) comes in as another approach. Like the name suggests, with PEN the child receives a large portion of their nutrition from the special formula, while a part of their diet may include some solid foods. For this reason, PEN and EEN combined highlight that a diagnosis of Crohn’s disease comes with viable options for a management, and offers diverse solutions to ensuring the child can have a good quality of life. Research shows that when PEN is combined with structured diets such as the Crohn’s Disease Exclusion Diet (CDED), it can be very effective in maintaining remission.¹⁴ PEN offers more flexibility, making it easier for children to stick with it long-term. 

Dietary Approaches Beyond Enteral Nutrition 

A common concern for families is whether children with Crohn’s disease can eat “normal food.” The short answer is yes. However, a carefully structured diet can mean that children get to support their gut healing journey while also enjoying a variety of foods. Certain structure food plans have been studied for their aid in relieving symptoms of Crohn’s: 

• Crohn’s Disease Exclusion Diet (CDED): Focuses on removing inflammation inducing foods while usually combining partial enteral nutrition. Evidence suggests this diet can lead to and maintain remission in children 
• Specific Carbohydrate Diet (SCD): Removes complex carbohydrates and processed foods. Some families report improvements, however evidence is mixed and more studies are needed
• Mediterranean-style diet: Prioritises fruits, vegetables, whole grains, and healthy fats. While not Crohn’s-specific, the Mediterranean Diet is known to support overall gut health¹³

Micronutrient Supplementation 

As discussed in Understanding Crohn’s, children with Crohn’s are at higher risk of developing micronutrient deficiencies due to malabsorption that impacts how well vitamins and minerals are absorbed from food into the body.^1,8

Common deficiencies include: 

• Iron (leading to fatigue) 
• Vitamin D and calcium (essential for bone health) 
• Vitamin B12 and folate (important for growth)
• Zinc (supports immunity)⁸

Supplements may be prescribed alongside dietary therapy to correct deficiencies in these nutrients. Consultation with your doctor is necessary as deficiencies can quietly affect the child’s growth and energy. 

Growth and Development 

One of the biggest concerns in paediatric Crohn’s disease is growth delay. Chronic inflammation, reduced appetite, and poor absorption of nutrients can cause children to fall behind in height and weight.³ Nutritional therapy and micronutrient supplementation directly supports growth by restoring calories, protein, and essential micronutrients that can strengthen bones and reduce inflammation, ultimately giving the body more energy to use for growing. Studies show that children treated with EEN are often able to “catch up” to their peers in height and weight, and may achieve greater outcomes than those treated only with steroid medication.¹²

What This Means For Children and Families 

Living with Crohn’s disease affects much more than the gut - that’s why emotional and social support are so important. Many hospitals offer counseling, peer support groups, or child psychologists to support children and families. Overall, all of the complications that come as a result of Crohn’s disease are coupled with solutions. With careful consideration and guidance, children with Crohn’s disease can enjoy a fulfilling social and family life. 

Summary 

• Nutrition is an integral component of Crohn’s disease management in children, offering many avenues for the condition’s improvement
• EEN is highly effective for inducing remission; PEN and CDED help with long-term management and maintenance of remission
• Micronutrient supplementation supports growth, energy, and bone health
• Nutritional strategies can reduce or completely avoid the long term side effects of medications such as steroids, improving overall quality of life from multiple angles
• With familial and clinical support, dietitian guidance, and ongoing research contributing to evidence-based treatment, children with Crohn’s can optimise their health and lead normal, active lives

Frequently Asked Question (FAQ)

Is exclusive enteral nutrition better than steroids for children with Crohn’s?

Yes, studies have shown that EEN is as effective as steroids for achieving remission in children, and without the negative effects on bone health and growth. 

Can my child eat “normal” food after remission? 

While it may take time to reintroduce foods after remission, most children can return to a varied diet. Some trigger foods may need to be avoided completely. A dietician can help to create a balanced plan. 

Are vitamins and minerals really that helpful? 

Supplements are often necessary where deficiencies in iron, vitamin D, and calcium can affect growth and developments.