Which therapy has NASPGHAN recommended as first-line induction therapy in pediatric Crohn's disease and has shown remission in up to 85% of cases?

• A. Corticosteroids
• B. Parenteral nutrition
• C. Gluten-free diet
• D. Exclusive enteral nutrition (EEN)

Answer: (D)

Exclusive enteral nutrition is the recommended first-line induction therapy for pediatric Crohn's disease because it achieves inflammation control and mucosal healing while supporting growth and development, avoiding the growth-suppressing side effects of steroids. By using a complete liquid formula as the sole nutrition source for about 6–8 weeks, the gut is given rest from whole foods while still receiving all necessary nutrients. In children, this approach can induce remission in a high proportion of patients—often reported up to around 85%—and it directly addresses growth and nutritional needs, which are critical in pediatric care.

Corticosteroids, while effective for inducing remission in many cases, carry significant risks for growing children, including impaired growth, bone health issues, and metabolic effects, which is why they’re not the preferred first-line option in this population. Parenteral nutrition is reserved for cases with severe malnutrition or specific complications and is not a standard induction therapy for Crohn's disease. A gluten-free diet is not an established induction therapy for Crohn's disease and isn’t recognized as a first-line approach for pediatric induction.