Ulcerative Colitis in Children and Adolescents

To make an appointment at the Pediatric IBD Center call 212-305-5903

What is Ulcerative Colitis?

Ulcerative colitis is a form of inflammatory bowel disease that affects the gastrointestinal (GI) tract, causing inflammation in the intestine. Ulcerative colitis affects the innermost lining of the large intestine (colon) and the rectum.

Both ulcerative colitis and Crohn’s disease, another common inflammatory bowel disease, often develop during adolescence or young adulthood and have similar symptoms. Differences between the two conditions include:

  • Ulcerative colitis affects only the large intestine, whereas Crohn’s disease can show up in any part of the GI tract, from the mouth to the rectum.
  • Ulcerative colitis is characterized by continuous areas of inflammation, beginning at the rectum and spreading outward. Crohn’s disease causes patches of inflammation. Non-affected parts of the GI tract remain healthy.
  • Ulcerative colitis affects the innermost layer of the colon. Crohn’s disease can affect multiple layers of the GI tract.

Because the immune system improperly attacks the GI tract, ulcerative colitis is considered an autoimmune condition. It is chronic (ongoing), and if not properly controlled in young patients, it can lead to permanent damage of the intestine as well as affecting growth, puberty, and bone health. It is most common in older children and young adults and affects males and females equally.

There is no cure, but with medical management, diet and lifestyle changes, and in rare cases surgery, many children and young adults with ulcerative colitis live active lives and sometimes achieve long-term remission.

What causes ulcerative colitis?

Scientists don’t know exactly what causes ulcerative colitis, but research shows that it is caused by a combination between genetics and environmental factors.

What are the symptoms of ulcerative colitis?

The most common symptom of ulcerative colitis is bloody diarrhea, caused by ulcers—or open sores—in the colon. Other symptoms include:

  • Abdominal pain
  • Urgent bowel movements
  • Weight loss
  • Low appetite
  • Fatigue

Less common symptoms include:

  • Skin lesions or rashes
  • Joint pain
  • Eye inflammation

Children and young adults with ulcerative colitis often experience periods of symptoms followed by periods of remission (no symptoms).

How is ulcerative colitis diagnosed?

Diagnosis of ulcerative colitis involves a full medical examination by a physician with expertise in inflammatory bowel disease. Your child will also be scheduled for some tests, which may include:

  • Blood tests to check for anemia and inflammation.
  • Stool sample to check for blood in the stool.
  • Imaging studies may include magnetic resonance enterography (MRE), CT scan, barium X-ray, DEXA scan and/or bone age assessment.
  • Colonoscopy examines the colon
  • Endoscopy uses a tiny camera to examine the small intestine.
  • Biopsy tests tissue samples that are taken during a colonoscopy or endoscopy.

If your child has received a diagnosis of ulcerative colitis and would like a second opinion or opportunity to discuss treatment options, please make an appointment with the Pediatric Inflammatory Bowel Disease Center.

How is ulcerative colitis treated?

The goal of treatment is to reduce symptoms and achieve remission. With long term medical and nutritional treatment and monitoring, most patients with ulcerative colitis go on to lead active, full lives. In some cases, surgery for ulcerative colitis is an option. Learn more about the Pediatric IBD Center.


Medications will most likely be part of your child’s long-term treatment plan. Medications are sometimes used in combination with each other, and they may be given orally, by injection, or intravenously.

  • Aminosalicylates contain 5-aminosalicylic acid (5-ASA), which reduces inflammation and helps control symptoms. It may be prescribed in pill form or as a suppository.
  • Antibiotics may be prescribed when infection is a concern, or in combination with other medications.
  • Steroids help reduce inflammation during a flareup of symptoms. They can also relieve symptoms such as rectal bleeding, fever, and joint pain.  Steroids may be given orally, topically, or intravenously.
  • Immunomodulators decrease immune system activity. They are generally used for patients who are not responding to other treatments.
  • Biologics target specific proteins that are known to cause inflammation. They are generally given intravenously to children in whom traditional medical therapy is not working or is causing side effects.  

Nutritional Therapy

Nutritional therapy will be a critical component of treatment of your child’s treatment plan and may be used in combination with one or more medications. Children need proper nutrition in order to grow and develop strong bones, and intestinal inflammation caused by ulcerative colitis can prevent the absorption of key nutrients.

There is no one-size-fits-all diet for ulcerative colitis, but research shows that dietary choices can affect inflammation. You will work with a nutritionist to develop a diet that helps reduce intestinal inflammation, promotes healing, and is achievable based on your family situation.


For some people, surgery is an option, especially for those who do not respond to medications or when medications stop working.

Surgery for ulcerative colitis is called colectomy and can eliminate the condition. Some or all of the large intestine is removed. In many cases, the small intestine is modified to create a new rectum, which is done in a second surgery.


People with ulcerative colitis require lifetime monitoring by a gastroenterologist with expertise in inflammatory bowel conditions. In children and adolescents, this is particularly important because they are still growing. Monitoring will be a key component of your treatment plan, so that we can help make sure treatment is leading to normal growth and development.