Challenges in the Management of Inflammatory Bowel Disease in Children: A Narrative Review.

There is a rising prevalence of pediatric inflammatory bowel disease (PIBD) worldwide. This article aims to explore the key issues in managing PIBD and attempts to propose evidence-based recommendations. We reviewed published literature on PIBD, including original research, systematic reviews, meta-analyses, consensus statements, and position papers. The databases searched were PubMed/MEDLINE, Cochrane Library, Web of Science, and Scopus, using terms related to inflammatory bowel disease, colitis, ulcerative colitis, Crohn's disease, children, adolescents, and pediatrics. The selected articles were critically appraised, summarised and incorporated into the review. PIBD presents multifaceted challenges. They include atypical presentations, very early onset cases, growth and nutritional challenges that affect linear development and pubertal progression, pharmacological management issues related to age-specific medication safety and efficacy and timing of surgical interventions. There are impacts on development; psychosocial burden challenges in education, social development, and family dynamics, all crucial in the future of the child. There are also limitations in access to PIBD services with personalised treatment approaches and challenges in transitional care. It is important to identify these unique challenges posed by PIBD and address them in a comprehensive manner in a multidisciplinary approach.