Growth in Paediatric Inflammatory Bowel Disease

ABSTRACT Impaired linear growth is a common, clinically meaningful complication of paediatric inflammatory bowel disease (IBD), particularly Crohn's disease, arising from the combination of chronic intestinal inflammation, undernutrition, dysfunction of the growth hormone–insulin‐like growth factor‐1 axis, and iatrogenic effects such as glucocorticoid exposure. Up to one in five children exhibit short stature at diagnosis, with higher risk in pre/early‐pubertal onset, small‐bowel involvement, persistent activity, and high cumulative steroid use. Although most patients ultimately achieve adult height close to their genetic potential, preventable height loss still occurs in vulnerable subgroups. Effective control of intestinal inflammation remains central to restoring growth velocity and IGF‐1 bioactivity. Specific nutritional strategies, including exclusive enteral nutrition and the Crohn's Disease Exclusion Diet with partial enteral nutrition, or anti‐TNF therapy are steroid‐sparing options that induce remission and support short‐term weight gain. Individualized energy and protein support, alongside vigilant correction of iron, vitamin D, and zinc deficiencies, is essential, and bone health requires proactive assessment in those with low BMI/height z‐scores or steroid exposure. Routine longitudinal monitoring of height, weight, BMI, and pubertal staging should be embedded as explicit treat‐to‐target outcomes, with early escalation to effective maintenance therapy when growth targets are unmet. Growth hormone therapy has a limited, adjunctive role and should be reserved for exceptional, refractory growth failure after optimization of disease control and nutrition within a multidisciplinary framework. Integrating growth and pubertal progression into standard paediatric IBD care can minimize irreversible deficits and improve lifelong skeletal and psychosocial outcomes.