Integrative and holistic treatments for IBD in children

Inflammatory bowel disease (IBD) is a chronic condition comprising of Crohn's disease or ulcerative colitis. Chronic health conditions can affect people of all ages and can be challenging to manage, especially for children.

"These inflammatory GI conditions are caused by some sort of trigger that sets off the immune system to react abnormally," says Srisindu Vellanki, M.D., a pediatric gastroenterologist at Children's Health℠ and Assistant Professor at UT Southwestern Medical Center. Over time, this inflammation in the gut can cause damage, including ulcers, bleeding, bloody stools, vomiting, diarrhea, lack of weight gain and poor growth.

Fortunately, there are many treatments available for IBD, including medications like steroids, aminosalicylate preparations, antibiotics, immunomodulators and biologics like Remicade, Humira, and small molecule drugs like Tofacitinib and Rinvoq.

Complementary medicine – including dietary therapy, mindfulness and yoga – can supplement these conventional approaches and provide holistic and needed support for many children, especially those suffering from chronic conditions like Crohn's disease and ulcerative colitis.

"Integrative medicine is particularly empowering for patients facing long-term illness who may feel like they have little control over their condition," says Dr, Vellanki. "We want to help these children understand that they have a role to play in their healing journey, which gives them back a feeling of control."

What is an "integrative" approach?

Integrative medicine is relationship-centered care that focuses on the whole person, including all aspects of lifestyle. It focuses on health rather than simply the absence of disease and makes use of an evidence-based approach by incorporating all appropriate therapies. Broadly, these approaches include special diets and supplements, including herbs, vitamins and minerals, as well as mind-body therapies like yoga, meditation, mindfulness, hypnotherapy, acupuncture and other healing systems.

"Our focus is to use integrative approaches plus all other conventional treatments like medications in an evidence-based way to achieve optimal health and well-being for our patients," says Dr. Vellanki. "We have a large toolbox to treat IBD in children, and we aim to make sure the treatment supports the whole patient as an individual."

That means going beyond a child's medical concerns to understand the mind-body connection – which has proven important for gut health and plays a role in conditions like Crohn's disease and ulcerative colitis.

What are the benefits of integrative medicine for IBD?

There is significant research on the mind-body connection that show integrative therapy practices like mindfulness have been quite effective in improving symptom management and quality of life, especially for disorders of brain-gut interaction (also known as functional GI disorders) as well as for IBD.

Complementary and alternative approaches are commonly used by patients with IBD: A 2018 study shows about a third to half of kids with IBD use some form of complementary or alternative therapy to treat their condition.

"Many of these approaches help patients feel better, even if they are not directly curing the underlying disease," says Dr. Vellanki. "That symptomatic relief can be a huge help for kids living with these chronic conditions."

Researchers are actively studying several approaches for integrative treatments for IBD, including dietary therapy and supplements.

"As providers, it's important we are aware of these different treatments and can guide each patient to the options that work best for their lifestyle," says Dr. Vellanki. "We work to understand the patient, their value system and their goals, and make sure we align with those."

What are some examples of integrative treatments for IBD in children?

Especially when working with children, an integrative health approach can help with understanding when and why IBD is being triggered and assist with easing those triggers. For example, if a child has a flare-up before a big exam, they can practice complementary stress reduction techniques before their next test to hopefully ease that flare-up next time. That can include:

• Breathing exercises
• Journaling
• Exercise
• Mindfulness
• Yoga

"A lot of these techniques are things that can be used safely under the guidance of a doctor to manage symptoms," says Dr. Vellanki.

One area that's become important for integrative IBD treatment is food. For children with mild Crohn's disease, if families are interested in a more natural approach, dietary therapies like exclusive enteral nutrition, in which most calories come from formula, have been helpful. Other newer diets, including the Crohn's disease exclusion diet, involve more solid food and recommend allowed and excluded foods to help induce remission.

Like conventional medicine, providers will continue to evaluate if integrative approaches work over time. "We check to make sure inflammation is getting better on endoscopic evaluation and blood work and that there are no complications from poorly controlled IBD," says Dr. Vellanki.

What are the limitations of integrative treatments for children's IBD?

One limitation of integrative approaches, says Dr. Vellanki, is that few large research studies have been completed: "It's still a new area of research, but we are actively thinking about how we can bring these approaches to the clinic."

While many integrative approaches, including mindfulness, healthy diet and exercise, are generally good for everyone, children need to stay connected with their physicians to understand the effects of their treatments.

"Mind-body therapies don't have many negative side effects and are considered very safe," says Dr. Vellanki. "Still, these practices are dose-dependent. That means that more practice means greater effects, and, especially for kids, it can be challenging to encourage them to continue these practices every day."

Additionally, many of the vitamins, minerals and supplements are not approved or evaluated by the Food and Drug Administration. Patients and parents should always collaborate with their providers to understand potential harmful side effects and possible interactions with conventional medicines.

Still, these approaches can bear fruit over time and offer physical and emotional benefits for children who adopt them under the supervision of their medical provider.

"Having a chronic condition, like IBD that can flare up at random times, can lead to feelings that children don't have control over their lives," says Dr. Vellanki. "A lot of this integrative approach is about bringing the patient into their healing journey and giving them ownership and control."

Having a chronic condition, like IBD that can flare up at random times, can lead to feelings that children don't have control over their lives.

Learn more

Together with our gastroenterology psychologists and IBD-focused registered dietitians, Children's Health provides a multidisciplinary approach that brings all your child's caregivers together in one clinic, under one roof, to create and manage their IBD care plan collaboratively. Learn more about the Children's Health Inflammatory Bowel Disease Program.