Treatment burden, adaptation, and support needs during exclusive enteral nutrition in children with Crohn's disease: a qualitative meta-synthesis.

OBJECTIVE

To synthesise child and adolescent accounts and caregiver and healthcare-professional perspectives on treatment burden, adaptation, and support needs during exclusive enteral nutrition (EEN) and early food reintroduction in paediatric Crohn's disease.

DESIGN

A multi-perspective qualitative meta-synthesis using the Joanna Briggs Institute (JBI) meta-aggregative approach.

DATA SOURCES: PubMed, Embase, Web of Science Core Collection, the Cochrane Library, Scopus, China National Knowledge Infrastructure, Wanfang, VIP, and the Chinese Biomedical Literature Database were searched from inception to 30 January 2026. Reference lists were examined for eligible reports and theses. A structured update of PubMed and targeted publisher, index, citation, and Chinese-language title sources was conducted on 20 July 2026. In response to peer review, CINAHL with Full Text (EBSCOhost) was searched from inception to 10 August 2026.

REVIEW

METHODS

Qualitative studies and mixed-methods reports with an identifiable qualitative component were eligible. Direct child or adolescent accounts were distinguished from caregiver proxy accounts and healthcare-professional perspectives, with findings labelled by treatment phase. Two reviewers independently screened reports, extracted findings and illustrations, and appraised qualitative components using the JBI checklist. Findings were assigned JBI credibility levels, synthesised inductively, assessed using ConQual, and examined in two sensitivity analyses: one restricted to four child-focused EEN reports and one excluding the two survey-based reports.

RESULTS

Six studies were included after reassessment led to the exclusion of one broader paediatric inflammatory bowel disease dietary study and one parent survey without an identifiable qualitative analysis. All six contained direct child or adolescent data; two also included caregiver data and one included healthcare-professional data. Twenty-two findings were grouped into eight categories and three synthesised findings: multiple burdens of EEN, reported adaptation and changing perceptions during EEN, and support needs across EEN and early food reintroduction. Both sensitivity analyses retained all three synthesised findings and all eight categories. ConQual confidence was moderate for each.

CONCLUSION

The evidence suggests that children and adolescents may experience EEN as demanding and socially visible. Caregiver and professional perspectives add context but should not replace children's accounts. Practice implications concerning early assessment, family support, school coordination, and food-reintroduction guidance are proposed considerations rather than established interventions.