Nutritional Approach in Pediatric Patients with Inflammatory Bowel Disease: Treatment, Risk and Challenges

Inflammatory Bowel Diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis (UC), have become a growing global health concern in children and adolescents. Pediatric-onset IBD presents unique challenges compared with adult-onset forms, including more extensive disease, impaired growth, delayed puberty, and psychosocial difficulties. While biologic and targeted therapies have advanced disease control, nutritional interventions remain a central component of management. Exclusive enteral nutrition (EEN) is recognized as the first-line therapy for inducing remission in pediatric CD, offering comparable efficacy to corticosteroids with additional benefits for mucosal healing, nutritional status, and growth. Modified dietary approaches, such as partial enteral nutrition and the Crohn's Disease Exclusion Diet (CDED), show promise for improving adherence and maintaining remission. However, dietary restrictions may lead to deficiencies and psychosocial stress, underscoring the importance of individualized, dietitian-supervised care. The role of nutrition in UC is less defined, but balanced, anti-inflammatory dietary patterns appear beneficial. This narrative review summarizes current evidence on nutritional strategies in pediatric IBD, highlighting their therapeutic potential, limitations, and integration with pharmacologic treatment within a multidisciplinary framework aimed at optimizing outcomes and quality of life.