How Nutrition Can Support Children with IBD

Nutritional therapies can lead to improved medical outcomes, as well as support growth and development for children with inflammatory bowel disease (IBD). Registered dietitians in CHOP’s Center for Pediatric IBD and Very Early Onset Inflammatory Bowel Disease (VEO-IBD) programs work closely with physicians and families to provide in-depth, individualized nutritional recommendations for patients with Crohn’s disease, ulcerative colitis, indeterminate colitis and very early onset IBD.

Dietitians specializing in pediatric IBD serve as an integral part of CHOP’s multidisciplinary team by providing medical nutrition therapies to patients and families visiting the IBD Center.

Dietitians can assist physicians with diagnosing and addressing disease-related malnutrition, as well as recommend nutritional interventions to correct malnutrition. Correcting malnutrition could lead to an increased response to pharmacotherapy.

An IBD dietitian may help a patient achieve goals including:

• Appropriate weight gain if indicated
• Reaching full linear growth potential
• Increasing dietary variety
• Gradually reducing BMI if indicated

The dietitian works closely with the IBD gastroenterologists to assess increases in nutrient losses associated with malabsorption, diarrhea, vomiting or intestinal protein losses.

IBD dietitians are clinical experts in all established dietary therapies used to help manage or treat IBD, including enteral nutrition therapy and partial enteral nutrition therapy. The dietitian creates the feeding plan for a patient following enteral nutrition therapy and provides the nutrition education. If pursuing enteral nutrition therapy, the dietitian will work closely with the provider to: 

• Calculate the child’s nutritional needs
• Recommend the appropriate formula selection
• Make vitamin/mineral adjustments
• Help families cooperate with nursing and homecare
• Support the physician to reduce the volume of calories provided from formula as the clinical course dictates
• Provide meal ideas and discuss allocation of calories from foods and/or formula

CHOP dietitians can also help uncover the reason patients with IBD may have difficulty meeting their nutritional needs, including:

• Following a restricted diet or self-excluding food groups
• Recognizing selective eating behaviors
• Identifying gastrointestinal symptoms impacting intake

A dietitian can team up with the family to add the right food or foods to help correct nutritional deficiencies, improve bone health, ensure adequate hydration and, in some cases, nutritionally rehabilitate. An office visit with a dietitian specializing in IBD is often coordinated before or after a visit with the gastroenterologist to offer convenience for families visiting the outpatient clinic. The dietitian supports the physician by completing a comprehensive nutritional assessment during the nutrition visit, which includes:

• Detailed diet history/analysis of a 3-day diet record
• Growth chart review, including examination of weights gains and linear growth velocity
• Performance of alternative anthropometrics such as mid-upper arm circumference, triceps skinfold or alternative
• height measurements
• Interpretation of pertinent nutrition-related lab results

A multidisciplinary clinic, such as CHOP’s VEO-IBD clinic, allows team members to operate in a shared workplace where the team – comprised of healthcare professionals including gastroenterologists, dietitians, nurses, a social worker, immunologist and research team members – can collaborate to provide an efficient and thorough evaluation in one office visit.

During this visit, the dietitian can provide appropriate diet recommendations, complete a nutrition assessment and diagnose malnutrition. Dietitians are available to help implement both short- and long-term goals, as well as provide follow-up visits in coordination with a patient’s infusions or scheduled follow-up visits with the GI provider. IBD dietitians also teach the nutrition component in a multidisciplinary education class offered monthly.

Working closely with CHOP’s medical chef educator, CHOP dietitians have created kid-friendly recipes for a fun spin on classic childhood meal and snack time favorites without any food additives or preservatives. Dietitians are valued team members who physicians can utilize in clinic to provide appropriate diet recommendations to help manage or treat IBD, and help families and children achieve their nutrition-related goals to support optimal growth and development.

— Natalie L. Stoner is a clinical dietitian in the Center for Pediatric Inflammatory Bowel Disease at CHOP.