Childhood Chronic ill health in childhood or adolescent IBD may result in growth failure, metabolic bone disease and delayed pubey. Loss of schooling and social contact, as well as frequent hospitalisation, can have impoant psychosocial consequences.Treatment is similar to that described for adults and may require glucocoicoids, immunosuppressive drugs, biological agents and surgery. Monitoring of height, weight and sexual development is crucial. Children with IBD should be managed by specialised paediatric gastroenterologists and transitioned to adult care in dedicated clinics . Pregnancy A women's ability to become pregnant is adversely affected by active IBD. Pre-conceptual counselling should focus on optimising disease control. During pregnancy, the rule of thirds applies: roughly one-third of women improve, one-third get worse and one-third remain stable with active disease. In the post-paum period, these changes sometimes reverse spontaneously. Drug therapy, including aminosalicylates, glucocoicoids Delayed growth and pubeal development: chronic active inflammation, malabsorption, malnutrition and long-term glucocoicoids contribute to sho stature and delayed development, with physical and psychological consequences. * Metabolic bone disease: more common with chronic disease beginning in childhood, resulting from chronic inflammation, dietary deficiency and malabsorption of calcium and vitamin D. * Drug side-effects and adherence issues: young people are more likely to require azathioprine or biological therapy than adults. Poor adherence to therapy is more common than with adults, as younger patients may feel well, lack self-motivation to adhere and believe that drugs are ineffective or cause side-effects. * Loss of time from education: physical illness, surgery, fatigue in chronic inflammatory bowel disease, privacy and dignity issues, and social isolation may all contribute. * Emotional difficulties: may result from challenges in coping with illness, problems with forming interpersonal relationships, and issues relating to body image or sexual function. Ref Davidson edition23rd pg823