Crohn's Disease in Children
Crohn's disease is when there is
redness, swelling (inflammation), and sores along the digestive tract. It is part
group of diseases known as inflammatory bowel disease, or IBD.
Crohn's disease is a long-term
(chronic) condition. It may come and go at different times in your child’s life. In
cases, it affects the small intestine, most often the lower part called the ileum.
some cases, both the small and large intestines are affected.
Sometimes the inflammation may affect the whole digestive tract. This includes the
mouth, the food pipe (esophagus), the stomach, the first part of the small intestine
(duodenum), the appendix, and the anus.
Experts don’t know what causes Crohn's disease. It may be that a virus or bacteria
affects the body's infection-fighting system (immune system). The immune system may
have an abnormal inflammation reaction in the intestinal wall that doesn’t stop.
Many children with Crohn's disease
have an abnormal immune system. But experts don’t know if immune problems cause the
disease. They also don’t know if Crohn's disease may cause immune problems.
Crohn's disease may happen at any age. It most often affects people ages 15 to 35.
But Crohn's may also occur in young children. It affects both males and females equally.
Children or teens may be more at
risk for Crohn's disease if they:
- Have a family history of Crohn's
disease. In most cases, this is a close relative such as a parent, sister, or
- Are white
- Are American Jews of European descent
- Live in developed countries, in cities, and in northern climates
Each child’s symptoms may vary. Symptoms may include:
- Belly (abdominal) pain, often in the lower right area
- Loose stool (diarrhea), sometimes bloody
- Rectal bleeding
- Weight loss
- Delayed growth
- Joint pain
- A cut or tear in the anus (anal fissure)
Some children may have no symptoms for a long time, even years. This is called being
in remission. There is no way to know when remission may occur or when your child’s
symptoms will return.
The symptoms of Crohn's disease may look like other health problems. Always see your
child's healthcare provider for a diagnosis.
Your child may be checked for signs
of Crohn's disease if your child has had long-term:
- Belly (abdominal) pain
- Loose stools (diarrhea)
- Weight loss
- A loss of healthy red blood cells (anemia). This can make your child feel tired.
Your child’s healthcare provider will take a health history and do a physical exam.
Other tests for Crohn's disease may include:
Blood tests. These are done to see if your child has fewer healthy red blood cells because of blood
loss. This is called anemia. These tests also check if your child has a higher number
of white blood cells. That might mean there is an inflammation problem. Other blood
tests can look for abnormal antibodies. The healthcare provider may use this result
to help diagnose or classify the disease.
Stool culture. This is done to see if an infection by a parasite or bacteria is causing the symptoms.
Endoscopy. This test checks the inside of part of the digestive tract. It uses a small, flexible
tube called an endoscope. The tube has a light and a camera lens at the end. Tissue
samples or biopsies from inside the digestive tract may also be taken for testing.
Colonoscopy. This test looks at the full length of the large intestine. It can help check for abnormal
growths, inflamed tissue, sores or ulcers, and bleeding. It uses a long, flexible,
lighted tube called a colonoscope. The tube is put into your child’s rectum up into
the colon. This tube lets the provider see the lining of the colon and take out a
tissue sample or biopsy to test it. Your child’s provider may also be able to treat
some problems that may be found.
Biopsy. A tissue sample is taken from the lining of the colon and checked in a lab.
Upper GI series or barium swallow. This test looks at the organs of the top part of the digestive system. It checks the
food pipe (esophagus), the stomach, and the first part of the small intestine (duodenum).
Your child swallows a fluid called barium. This is a thick, chalky fluid. It is used
to coat the inside of organs so that they will show up on an X-ray. Then X-rays are
taken to check the digestive organs.
Lower GI series or barium enema. This test checks the large intestine, including the colon and rectum. A thick, chalky
fluid called barium is put into a tube. It is inserted into your child’s rectum as
an enema. Barium coats the organs, so they can be seen on an X-ray. An X-ray of your
child’s belly will show if there are any narrowed areas called strictures. It will
also show any blockages or other problems.
CT enterography or MR enterography. These imaging tests look at the small bowel and can show any inflammation or complications.
Capsule endoscopy. This is a special capsule that your child swallows. The capsule is a camera that
takes pictures of the small bowel.
Crohn's disease is a long-term
(chronic) disease. There is no cure for it. But there are some things that can help
control it. Treatment for the disorder has 4 goals:
- Correct nutritional problems
- Control the swelling and inflammation
- Ease symptoms such as belly pain, diarrhea, and rectal bleeding
- Keep complications from occurring. These include tunnels of inflammation to other
organs (fistulas) and narrowing of the intestine (stricture) that causes blockages.
Your child’s healthcare provider will create a care plan based on:
- Your child's age, overall health, and medical history
- How serious your child’s case is
- How well your child handles certain medicines, treatments, or therapies
- If your child’s condition is expected to get worse
- Your opinion and what you would like to do
Your child’s treatment may include the following.
Medicines often reduce the inflammation in the colon. This may help ease belly cramps
and diarrhea. More serious cases may require steroids, antibiotics, or medicines that
affect the body's immune system.
Making some changes in your
child’s diet may help to ease symptoms. In some cases, symptoms are made worse by
milk, hot spices, or fiber. Talk with your child’s provider. Your child may use a
special meal plan called an elemental diet.
Vitamins may help prevent some problems or help maintain a remission. Because many
children with Crohn's don't absorb nutrients normally, vitamin deficiencies are common.
Your child may need lab tests to assess the nutrient levels. Talk with your child’s
provider about any vitamin supplements. These treatments have risks and may cause
harmful side effects.
Your child’s provider may suggest nutritional supplements or special high-calorie
liquid formulas. These may be helpful if your child has delayed growth.
IV or intravenous feeding
In rare cases, IV feeding may be
used for children who need extra nutrition for a short time.
Surgery may help Crohn's
disease, but it can’t cure it. Surgery may help to reduce long-term symptoms that
don’t get better with medicine. Surgery may also fix some problems. These include
blocked intestine, a hole or perforation, a sore or abscess, or bleeding. Types of
surgery may include:
Draining abscesses in or near fistulas. An abscess is a collection of pus or infection. Treatment includes antibiotics, but
surgery may be needed.
Bowel or intestinal resection. The diseased section of intestine is removed. The 2 healthy pieces of intestine are
attached. This surgery shortens your child’s intestines.
Ostomy. When part of the intestines is removed, a new way of removing stool from the body
is created. The surgery to create the new opening is called an ostomy.
Children with Crohn's disease may
lose weight because they don’t get enough calories. This can happen because a child:
- May not eat to prevent the pain that
is linked to digestion
- May want to eat only favorite
- May not absorb nutrients well through the inflamed digestive tract
- Has greater nutritional needs than normal because of the disease
Nutritional supplements or special
high-calorie liquid formulas may be suggested. These are often advised if a child
Crohn's disease may also cause
other health problems, such as:
- A blocked intestine
- A type of tunnel, called a fistula, in nearby tissues. This can get infected.
- Rips or tears, called fissures, in the anus
- Problems with liver function
- A lack of some nutrients, such as calories, proteins, and vitamins
- Too few red blood cells or too little hemoglobin in the blood (anemia)
- Bone weakness, either because bones are brittle (osteoporosis) or because bones are
- A nervous system disorder where legs feel painful, called restless leg syndrome
- Skin problems
- Eye or mouth redness or swelling (inflammation)
After bowel resection surgery, a condition called short bowel syndrome can occur.
It often happens after a large part of the small intestine is removed. The body then
may not be able to digest and absorb some vitamins, foods, and nutrients, including
water. This poor absorption of food and nutrients is called malabsorption. It causes
diarrhea. It can also lead to poor growth and development. Common symptoms of malabsorption
- Loose stool (diarrhea)
- Large amounts of fat in the stool (steatorrhea)
- Weight loss or poor growth
- Fluid loss or dehydration
- Lack of vitamins and minerals
Crohn's disease is a long-term
(chronic) condition. It may come and go at different times during your child’s life.
Children may have physical, emotional, social, and family problems as a result of
disease. It’s important to work closely with your child’s healthcare provider to manage
and treat the condition.
Be sure to have the provider check
your child’s health on a regular basis. This includes checking your child's:
- Nutrition levels
- Bone mineral density
- Risk for infections
- Immunization status
- Any liver, eye, or skin problems
- Emotional well-being
Emotional stress can make Crohn's disease worse. Children may be
helped by seeing a mental health provider who can teach them stress-reduction
techniques. Your child may also have depression or anxiety. This disease can be
especially frustrating for teens because flareups can make them more dependent on
parents at a time when they want their independence.
No special diet has been shown
to treat Crohn's disease. Many children with the disorder can eat a fairly normal
diet when their disease is stable. Talk with your child’s healthcare provider. When
your child is having symptoms, it may be helpful if your child follows these
- Eat smaller, frequent meals.
- Limit foods with milk or milk
products containing lactose, if there is a history of lactose intolerance.
- Don't eat greasy foods.
- Don't eat certain high-fiber foods
such as popcorn, nuts, and seeds.
- Don't eat any foods that seem to
have triggered symptoms in the past.
- Drink liquids at room
- Drink liquids between meals, not
- Stay away from caffeine.
- Don't eat foods with sorbitol,
xylitol, and mannitol.
- Don't eat sweets, such as candy,
cakes, and pies.
Don't eat foods that produce
more gas, such as:
Eat foods that have more soluble
fiber. This is fiber that absorbs water. Foods that are good sources of soluble fiber
Children who have short bowel
syndrome after surgery for Crohn's often have problems with diarrhea and
malabsorption. Talk with your child’s healthcare provider about how to treat these
Children with short bowel
syndrome often need help getting all the nutrition they need. Supplemental liquid
feedings are sometimes done using total parenteral nutrition (TPN). TPN is a special
mix of glucose, protein, fat, vitamins, and minerals. It is given by IV or
intravenously in the vein.
When to Call a Healthcare Provider
Call your child’s healthcare provider if your child has symptoms of Crohn's disease,
- Belly pain
- Loose stool
- Rectal bleeding
- Weight loss
- Vomiting that continues
- Sores (lesions) or leakage at the anus
Call your child's provider right away if your child has Crohn's disease and regular
symptoms change or new symptoms appear.
- Crohn's disease is when there is
redness, swelling (inflammation), and sores along the digestive tract.
- It is a type of inflammatory bowel
- In most cases, it affects the small
intestine. But it may also affect the whole digestive tract.
- It is a long-term (chronic) condition.
It may come and go at different times in your child’s life.
- There is no cure. Making some diet
changes may help ease symptoms.
- Medicine may help. Surgery may be
needed. Medicines are usually needed for the long term.
- The disease can result in emotional problems such as depression
and anxiety. A child's mental health needs to be watched. Get professional help when
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a
new diagnosis and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.