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Digestive and Gastrointestinal Conditions

Short Bowel Syndrome


What is short bowel syndrome?

Short bowel syndrome (SBS) means a child’s small bowel (small intestine) isn’t long enough and doesn’t work well enough to absorb the nutrients they need from the food they eat.

During digestion, muscles in the small bowel squeeze to push food along. As the food travels through the bowel, it comes in contact with the thin lining (mucosa) inside the bowel. Nutrients – like carbohydrates, protein, fat, vitamins and minerals – get absorbed through this lining as part of normal digestion.

There must be plenty of contact between the food and lining of the bowel to absorb enough nutrients. A healthy small bowel has more than enough length to digest food and absorb nutrients. So removal of small segments (portions) of the bowel usually does not cause problems. But if the bowel is too short, such as after removal (resection) of a large segment, there is not enough contact for good absorption.

This is why SBS can cause malnutrition and serious problems with growth and development. Without treatment, SBS can be deadly.

Short Bowel Syndrome in Children


Children develop SBS because they have had a very large segment of their bowel removed. Usually this happens because they were born with a condition that damaged their small bowel, such as gastroschisis.

SBS can also occur in children because their bowel didn’t form completely before birth (intestinal atresia). They may have a segment of bowel missing, or doctors may have removed a segment that was closed off from the rest of the bowel.

Children can also develop SBS because of conditions that begin after birth. These include necrotizing enterocolitis, volvulus (twisting of the intestines) or trauma (injury) to their bowel.

Rarely, children may have abnormal nerves throughout their intestine. Their small intestine may be a normal length but not work normally. These children may have intestinal pseudo-obstruction or long-segment Hirschsprung’s disease.

SBS is the most common cause of intestinal failure.


Children with SBS need other sources of nutrition in addition to the food they eat by mouth. Without other sources of nutrition, they will not get enough nutrients to survive and grow.

Many children with SBS need to be fed through a tube that goes into a vein (intravenous, or IV, feeding). This is called parenteral nutrition (PN). They may also need to be fed through a tube that goes into the gastrointestinal tract. This is called enteral nutrition.

Short Bowel Syndrome at Seattle Children’s

Intestinal Care Program

Seattle Children’s has the only complete pediatric intestinal care program in the Pacific Northwest. This program helps restore intestinal function in children with SBS or other types of intestinal failure. It brings together doctors who specialize in the stomach and intestines (gastroenterologists), liver doctors (hepatologists), pediatric surgeons, nurses, nutritionists, social workers, pharmacists and others — many with advanced training in SBS. They work one on one with each family to create a treatment plan for their child.

We also have an experienced home care services staff to help you with parts of your child’s care at home, like nutrition, tube feeding, blood draws and IV nutrition.


Most children with SBS can get the nutrition they need using diet and medicine. But in some cases, they may need surgery. Our surgeons are experienced at doing the surgeries these children may need, including the STEP (serial transverse enteroplasty) procedure. The STEP is a way to lengthen a shortened bowel in children with short bowel syndrome. Seattle Children’s participates in the International STEP Registry, a project to collect and analyze data about STEP and the patients who undergo it. Each year, our surgeons perform about four to six of these surgeries.


If other treatments are not enough, a child with SBS may need an intestine transplant. Seattle Children’s has the only program for children in the Pacific Northwest and one of the few nationwide with specialists who can perform intestine transplants. Read more about our Liver and Intestine Transplant Clinic.

We are one of 18 hospitals in North America that make up the Pediatric Intestinal Failure Consortium. This group is dedicated to studying treatment of intestinal failure and the long-term outcomes. Many of our doctors and surgeons are active in clinical and translational research related to intestinal failure and intestinal transplant.

Focus on children

Since 1907, Seattle Children’s has been treating children only. Our team members are trained in their fields and also in meeting the unique needs of children. For example, the doctors who give your child anesthesia are board-certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age. Our expertise in pediatrics truly makes a difference to our patients and families.

Should your child see a doctor?

Find out by selecting your child’s symptom or health condition in the list below:

Summer 2014: Good Growing Newsletter

In This Issue

  • Understanding the Power and Influence of Role Models
  • Legal Marijuana Means Greater Poisoning Risks for Children
  • Why Choose Pediatric Emergency Care?

Download Summer 2014 (PDF)