Kids with Crohn’s: The guide to help parents manage Crohn’s Disease with a liquid diet (EEN)

What is a liquid diet (medically known as EEN)?

Exclusive Enteral Nutrition (EEN) is a dietary strategy where regular meals are replaced by a specially formulated liquid. The liquid is designed to provide all the nutritional needs including calories, protein, vitamins and minerals, to satisfy a child’s development as they work towards healing a diagnosis of Crohn’s Disease.

Why is my child on a liquid diet?

Your child is on a liquid diet (EEN) to support the management of conditions like Crohn’s. EEN is a thoroughly researched approach and a technique I have applied with success. The underlying rationale is to give the body the ability to focus on healing of the gut, rather than digesting food. EEN is a specially formulated liquid that provides the necessary nutrition during this stage of growth and development.

What is Crohn’s Disease in a child?

Crohn's disease is a type of inflammatory bowel disease (IBD). It presents as chronic inflammation in the digestive tract. In children, the condition can affect any part of the gastrointestinal tract, from the mouth to the anus.

What are the most common symptoms in children with Crohn’s?

Abdominal pain,
diarrhoea,
weight loss,
fatigue, and
delayed growth.

What are the benefits of a liquid diet (EEN)?

A liquid diet (EEN) helps to:

Reduce inflammation in the digestive tract, a key factor in managing Crohn’s disease,
Improved symptom control, including reduced abdominal pain, diarrhoea and fatigue,
Provides the right level of nutritional support to ensure proper growth and development,
Promotes healing by temporarily replacing solid food with a liquid diet,
Weight restoration by providing adequate calories for children who may have experienced weight loss due to Crohn’s disease,
Promotes growth, important to address potential growth delays commonly associated with Crohn's,
Addresses individual needs, as the liquid formulas can be tailored to meet the specific nutritional needs of the child,
Improved quality of life, by minimising the impact of Crohn’s on a child’s daily life activities.

How long will my child need to be on a liquid diet (EEN)?

Your gastroenterologist will inform you of the length of time your child will be on EEN. In my experience, it is between 6 - 8 weeks, depending on the severity of the condition your child is experiencing.

How is a liquid diet (EEN) administered?

The liquid formula is prescribed through your GP or gastroenterologist as a nutritional drink they consume. We will trial this approach first, however if this is proving too difficult to achieve, your child may need to consider using a nasogastric tube to complete the full EEN period.

Here are some tips when following a liquid diet

Consistency is key - stick to the exclusive liquid plan without solid foods, for optimal results
Stay hydrated - to keep up their water intake, give your child cold drinks frequently
Small, frequent sips - prevent hunger by taking small sips throughout the day rather than large quantities at once
Be positive - offer praise and positive reinforcement to keep your child motivated
Get them involved - help your child understand the importance of EEN and give them the power to make decisions, age appropriately
Stick to a routine - to improve consistency and compliance, establish a routine to make it more predictable and part of daily life
Create a support system - make your child feel supported by engaging friends, family and teachers
Talk to your IBD team (gastroenterologist, dietitian, IBD nurse) if you have any questions or concerns

And some tips to improve compliance, by keeping your child interested in consuming the formula

Change the texture by freezing the formula to a mousse style
Make it into a frappe by blending it with ice cubes
Warm the formula slightly, and let them enjoy the temperature change, like a hot chocolate
Try different formula flavours to find their favourites

Other foods you can have during the EEN period

Fruit teas (non caffeinated)
Lemonade
Polo mints
Home made or packaged bone broths (e.g. Maggie’s bone broths)

How to reintroduce food after a liquid diet

I will definitely guide you through this milestone event. Once your child’s gut shows improvements, which will be monitored with your Gastroenterologist, we will start the plan to reintroduce foods. In many cases, it’s a measured and gradual process, as the formula is reduced over several days as more solid food meals are introduced..

Here is a general guide on the meal plan we will follow:

What about the Crohn’s Disease Exclusion Diet (CDED)?

We will also consider the Crohn's Disease Exclusion Diet (CDED) as an alternative plan for your child if the initial EEN period is proving too difficult. This approach is on using whole foods, rather than only a liquid diet. The focus is on removing or lowering certain foods that are considered problematic for children with Crohn's disease. At the same time, it includes more of the foods that build a healthy gut microbiome. EEN is always a first option as it is the most evidenced based method for managing Crohn’s Disease.

It’s essentially a hybrid model, being a combination of food elimination, food reintroduction, supported with partial EEN. I’ve seen great results from following this plan but it requires a detailed discussion, which we will have during our consultation, once I get to know your child’s particular situation.

Why would CDED be considered?

EEN is a challenging diet for adults, let alone children. It’s extremely restrictive, making compliance difficult. In research studies, CDED has been proven to be as effective in its results with easier implementation.

In some instances we may even consider this approach in addition to EEN to maximise results for continued remission of Crohn’s Disease, after your EEN period has finished.

How can a certified Paediatric Dietitian help?

Once Crohn’s has been diagnosed I will work with you and your child to manage the nutritional treatment plan, including EEN and possibly CDED. I’ve worked with many patients and families through the process and bring all this experience to your situation. Following the initial consultation, I will be supporting your child through their individualised nutrition plan. Please feel free to ask any questions or raise concerns you encounter. I am there for you and your child.

Working with me is easy. Just follow these 3 steps and we’ll get you and your child on the road to peace, health and happiness.

Book an appointment: in-person or online video call

I’ll meet with you and your child via telehealth or face to face. We’ll discuss your child’s full history from birth until today and answer all your questions.