Key points to remember about ulcerative colitis treatment

• treatment options depend on how severe your child's ulcerative colitis is
• children with IBD unclassified (IBDU) will also receive ulcerative colitis treatment
• treatment for children with ulcerative colitis may include medicines
• talk to your doctor about your child's medicines and make sure you know the names and doses of the medicines, the side effects and why your child is taking them
• with effective treatment, it is possible to manage your child's symptoms and prevent flare-ups

What are the treatment options for my child with ulcerative colitis?

The aims of treatment for ulcerative colitis are to control inflammation, relieve symptoms, make sure your child is growing well and has the vitamins and minerals they need. Some children may need to see a dietitian as part of their treatment.

Treatment options depend on how severe your child's ulcerative colitis is. Your child's paediatrician or other specialist will talk with you and your child about the best treatment.

With effective treatment, it is possible to manage your child's symptoms and prevent flare-ups, though it may take some time to find the best treatment for your child.

How can medicines help my child with ulcerative colitis?

The aims of treatment with medicines

Treatment for children with ulcerative colitis may include medicines to:

• stop or control the inflammation
• stop the disease from getting worse, or keep your child free from symptoms
• prevent the immune system from attacking the body and causing the inflammation - your child may have some of these medicines by injection or infusion in hospital
• control pain
• provide the body with missing vitamins and minerals

Being informed about your child's medicines

It is important to talk to your doctor about your child's medicines. You should know the names and doses of the medicines, the side effects and why your child is taking them.

Alternative medicines

Your friends and family may suggest trying alternative medicines or treatment. Please discuss these with your doctor first, as some therapies can be harmful or may interact with your child's current medicines.

What medicines might my child with ulcerative colitis need?

Aminosalicylates

These are often the first treatment option for children with mild to moderate symptoms and for mild flare-ups in the lower large bowel (intestine). Examples include mesalazine, which your child may take as tablets, capsules, or granules, or by enema or suppository in their bottom (rectum or back passage). As well as mesalazine, there are other aminosalicylate medicines your child may have (such as olsalazine and sulfasalazine).

Steroids

These are for treatment of sudden flare-ups. These are not usually for long-term use. Examples include budesonide, prednisone and methylprednisone which your child may take as tablets or capsules, liquid or receive directly into a vein (IV or intravenous) [1], or hydrocortisone by enema in their bottom (rectum or back passage).

Immunosuppressants

Your doctor may prescribe these if your child's symptoms don't improve when they take mesalazine. An example is azathioprine.

Biologics (TNF inhibitors)

TNF inhibitors are for children with severe ulcerative colitis, or for children whose symptoms don't improve when they take other medicines. Examples include infliximab and adalimumab. Your child will receive TNF inhibitors by injection.

Vitamins and minerals

Ulcerative colitis can cause problems with absorption of vitamins and minerals so some children will need vitamins and mineral supplements. These are likely to include iron and vitamin D. They might also include vitamin B12, folate, magnesium and calcium.

Can nutrition and diet help my child with ulcerative colitis?

If your child has ulcerative colitis, they can usually eat a normal, balanced diet.

There may be times when changes in your child's eating habits can help control their symptoms and prevent flare-ups. You may find it helpful to keep a diary of what your child eats and drinks each day to see which foods may be making their ulcerative colitis symptoms worse. Useful tips for your child are:

• avoid spicy foods or oily, fatty foods
• limit raw fruits and vegetables to prevent irritation to the inflamed lining of the colon (large intestine) - this may result in reduced symptoms
• try limiting milk or other dairy products - a milk-free diet may also decrease symptoms in some children but if there's no improvement, start these foods again
• avoid fizzy drinks and caffeine
• try eating small meals more frequently rather than large meals

When your child is well, there is no reason for them to avoid certain foods. It is important that your child eats a full and varied diet.

Can a low FODMAP diet help my child with ulcerative colitis?

​A low FODMAP diet (a diet that avoids certain sugars) does not treat ulcerative colitis. Studies show that no particular food is useful in treating ulcerative colitis. A low FODMAP diet can be useful in treating irritable bowel syndrome (IBS). But, IBS is not the same as ulcerative colitis and the treatments are very different. Some children with ulcerative colitis may also have IBS. It is important to talk with your child's doctor and dietitian before making any significant changes to your child's diet.

Will my child with ulcerative colitis need surgery?

Some children with ulcerative colitis may need surgery if medicines don't work well enough. Your child's doctor will talk to you about this, if necessary.

In children with very severe ulcerative colitis, an operation to remove the colon (large intestine) can remove all the disease and work really well. This option is only for after a child has tried medicines.