Ulcerative Colitis - children - discharge

Your child probably received fluids through an intravenous (IV) tube in their vein. They may have received:

• A blood transfusion
• Nutrition through a feeding tube or IV
• Medicines to help stop diarrhea

Your child may have been given medicines to reduce swelling, prevent or fight infection, or help the immune system.

Your child may have had surgery, such as:

• Removal of colon (colectomy)
• Removal of the large intestine and most of the rectum
• Placement of an ileostomy
• Removal of a part of the colon

Your child will likely have long breaks between flare-ups of ulcerative colitis.

When your child first goes home, they will need to drink only liquids or eat different foods from what they normally eat. Follow the instructions given by your child's health care provider. Ask the provider when you can start your child's regular diet.

You should give your child:

• A well-balanced, healthy diet. It is important that your child get enough calories, protein, and nutrients from a variety of food groups.
• A diet low in saturated fats and sugar.
• Small, frequent meals and plenty of liquids.

Certain foods and drinks can make your child's symptoms worse. These foods may cause problems for them all the time or only during a flare-up.

Try to avoid the following foods that can make your child's symptoms worse:

• Too much fiber may make symptoms worse. Try baking or stewing fruits and vegetables if eating them raw bothers them.
• Avoid giving foods that are known to cause gas, such as beans, spicy food, cabbage, broccoli, cauliflower, raw fruit juices, and fruits, especially citrus fruits.
• Avoid or limit caffeine, as it may make diarrhea worse. Foods such as some sodas, energy drinks, tea, and chocolate can contain caffeine.

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

Talk with a dietitian to make sure your child is getting proper nutrition. Be sure to do this if your child has lost weight or their diet becomes very limited.

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. CCFA offers a list of resources, a database of doctors who specialize in treating Crohn disease, information about local support groups, and a website for teens - www.crohnscolitisfoundation.org.

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. Your child may also need a prescription for stronger pain medicines.

There are many types of drugs available to prevent or treat attacks of your child's ulcerative colitis.

Your child's ongoing care will be based on their needs. The provider will tell you when your child should return for an exam of the inside of their rectum and colon through a flexible tube (sigmoidoscopy or colonoscopy).

Contact the provider if your child has:

• Cramps or pain in the lower stomach area that do not go away
• Bloody diarrhea, often with mucus or pus
• Diarrhea that cannot be controlled with diet changes and drugs
• Rectal bleeding, drainage, or sores
• New rectal pain
• Fever that lasts more than 2 or 3 days or a fever higher than 100.4°F (38°C) without an explanation
• Nausea and vomiting that lasts more than a day
• Skin sores or lesions that do not heal
• Joint pain that keeps your child from doing everyday activities
• A feeling of having little warning before needing to have a bowel movement
• A need to wake up from sleeping to have a bowel movement
• Failure to gain weight, a concern for your growing infant or child
• Side effects from any medicines prescribed for your child's condition

UC - children; Inflammatory bowel disease in children - UC; Ulcerative proctitis - children; Colitis in children - UC

Bitton S, Markowitz JF. Ulcerative colitis in children and adolescents. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 43.

Stein RE, Baldassano RN. Inflammatory bowel disease. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 362.

Updated by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.