About Childhood IBD

• Crohn’s disease and ulcerative colitis are inflammatory bowel diseases (IBD). They are chronic and painful disorders that affect the intestinal tract.
• Ten percent, or 140,000, of the estimated 1.4 million Americans who suffer from IBD are under the age of 18.
• Approximately 20 percent of patients have another family member with IBD, and families frequently share a similar pattern of disease.
• IBD, which has been detected in infants as young as 18 months, can be particularly hard to diagnose in children.

Symptoms

• The initial symptoms may be nonspecific weight loss or delayed growth. For example, 80-90 percent of children with Crohn’s disease experience weight loss. For this reason, the correct diagnosis can be difficult to make: The average delay in diagnosis is three years from the onset of symptoms.
• Other symptoms range from mild to severe and life-threatening and include any or all of the following:
  • persistent diarrhea,
    abdominal pain or cramps,
  • rectal bleeding,
  • intermittent fever,
    inflammation of joints (arthritic-like symptoms),
  • inflammation of skin or eyes, and
  • skin nodules and ulcers.
• Sixty to 90 percent of children with Crohn’s disease and 14 percent of children with ulcerative colitis experience growth failure.

The Etiology of IBD

• Both the causes of and medical cures for IBD are unknown. Colectomy (surgical removal of the colon) is the only cure for ulcerative colitis. There is no cure for Crohn’s disease; while surgery may be needed to help control symptoms or treat complications, relapses are common.
• There is no link between eating certain kinds of foods and IBD. However, dietary modifications, especially during flare-ups, can help reduce symptoms and replace lost nutrients.
• IBD is not a psychosomatic illness. There is no evidence to suggest that emotions play a causative role, but emotional stress can affect symptoms.

Treatment

• In younger patients, IBD tends to be more aggressive than in adults; thus, more aggressive treatment is needed.
• Medications currently available alleviate inflammation and reduce symptoms but do not provide a cure. The principal drugs used to treat Crohn’s disease and colitis are 5-ASA agents (e.g., sulfasalazine, mesalamine) and corticosteroids (e.g., prednisone).
• Prednisone can cause physically and emotionally disturbing side effects in children, including acne, puffy faces, weight gain, and growth retardation.
• Sometimes, special nutritional therapy is needed to successfully treat IBD in children, because their maturing bodies require more vital proteins, vitamins, calories, and minerals.
• A child who suffers from growth failure may require tube feedings or total parental nutrition (TPN)–intravenous feedings that fulfill all nutritional requirements. In some severe cases, surgery becomes the only option.
• An estimated two-thirds to three-quarters of children with Crohn’s disease will require one or more operations in their lifetime.