Crohn’s Disease In Children: Symptoms, Causes And Treatment
Gastrointestinal symptoms, malnutrition, and growth failures are common in the pediatric population with Crohn's disease.
Specialty: Masters of Tropical PediatricsExperience: 26 yearsDr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.
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In This Article
Crohn’s disease is a type of inflammatory bowel disease (IBD), as is ulcerative colitis. Crohn’s disease in children can affect any part of their gastrointestinal tract, from the mouth to the anus. However, it mostly affects the end of the small intestine (ileum) and the beginning of the large intestine (colon). This condition causes inflammation and ulceration in the intestine or bowel, which can have damaging effects on the entire bowel wall.
Crohn’s disease has no particular cure, and the current treatment strategies aim to control complications and relieve symptoms. The therapy also includes measures to meet a child’s nutritional requirements for adequate growth and development.
Read on to know about the causes, risk factors, symptoms, complications, dietary modifications, and treatment for Crohn’s disease in children.
Causes Of Crohn’s Disease
The exact cause of Crohn’s disease is not yet known. It may occur due to changes in genetic or immunity factors. Stress and dietary factors were thought to cause this disease in earlier times. However, new studies indicate that these factors may aggravate the condition but not cause it (1).
The genetic link of Crohn’s disease is suspected since some children may have a positive family history. However, this cannot be confirmed since all may not have an affected family member or relative.
An abnormal immune response to a viral or bacterial infection is also thought to cause Crohn’s disease. Cross-reaction of the immune system to the intestinal wall may trigger inflammation. Although immune system reactions are seen in intestines during Crohn’s disease, it is unclear whether Crohn’s disease triggers these reactions or vice versa.
Risk Factors For Crohn’s Disease
The following risk factors may play a role in the development of Crohn’s disease in some children (1).
- Family history: Children with affected parents or siblings (first-degree relatives) may have a higher risk of developing the disease than others.
- Genetics: Individuals of certain communities, ethnicities, or gene pools could be at a higher risk of developing the conditions than others.
- Nonsteroidal anti-inflammatory medications: Ibuprofen, diclofenac, and naproxen may increase the risk of bowel inflammation in some children.
- Frequent antibiotic use: The persistent use of antibiotics may increase the risk of Crohn’s disease in some children.
Some children may develop Crohn’s disease without displaying any risk factors. However, controlling the risk factors may help to avoid the disease and its complications in some children.
Signs And Symptoms Of Crohn’s Disease
The signs and symptoms and their severity may vary in children. Some of the common signs and symptoms of Crohn’s disease could include the following (2).
- Abdominal pain, especially in the right lower part
- Diarrhea, some may have bloody diarrhea
- Loss of appetite
- Mouth sores
- Weight loss
- Delayed growth
- Fever
- Anal fissure
- Rectal bleeding
- Joint pain
- Skin rashes
- Anemia
Some patients may be in remission for a long time, which means they are free of symptoms, even for years. There is, however, no way to know when remissions may occur or when your child’s symptoms will return. Seek medical care if your child has any of the above-listed symptoms for exact diagnosis and treatment.
Complications Of Crohn’s Disease
Growth delay and weight loss can be seen in most children with Crohn’s disease due to the malabsorption of nutrients. Although the affected intestines can still absorb nutrients, some children may avoid eating enough food due to symptoms.
Crohn’s disease may also result in the following complications in some children (3).
- Intestinal obstruction or blockage
- Fistula, this is the formation of a tunnel from the inflamed part of the intestine to nearby tissues and often results in infections
- Skin problems
- Anal fissures (rips or tears in the anus)
- Arthritis and bone weakness due to osteoporosis (brittle bones) or osteomalacia (soft bones)
- Restless leg syndrome is a nervous system disorder with painful legs
- Gallstones
- Liver problems
- Anemia due to blood loss
- Mouth and eye inflammation
- Colon cancer
Types Of Crohn’s Disease
Crohn’s disease can be of various types based on the affected part of the GI tract (4).
- Ileocolitis is the most common type. It inflames the end of the small intestine (ileum) and a portion of the large intestine (colon). Pain, significant weight loss, and diarrhea are usually seen in this type.
- Ileitis only inflames the last section of small intestine. Symptoms can be similar to ileocolitis and often result in complications, such as fistulas and inflammatory abscess, in the right lower part of the belly.
- Gastroduodenal Crohn’s disease inflames the stomach and duodenum (the beginning part of the small intestine). Nausea, vomiting, and reduced appetite with weight loss are usually seen in this type.
- Jejunoileitis involves patchy areas of inflammation of the middle part of the small intestine (jejunum and ileum). Diarrhea and mild or severe cramps after meals are common symptoms of this type. This may often complicate into fistulas after long periods of inflammation.
- Crohn’s or granulomatous colitis inflames the colon. This type may be associated with diarrhea and rectal bleeding in children. Joint pains and skin lesions are common complications of granulomatous colitis. Abscesses, fistulas and ulcers around the anus are also seen in this condition.
The symptoms and complications may vary depending on the type. You may discuss with the doctor to know the type of Crohn’s disease after the diagnostic tests.
Diagnosis Of Crohn’s Disease
Long-term signs and symptoms can be suggestive of Crohn’s disease in children. The following tests are ordered to confirm the diagnosis (5).
- Blood tests are useful to identify specific antibodies and inflammatory markers. A blood count may show fewer red blood cells due to blood loss.
- Endoscopy is done to visualize any abnormalities of the upper part of the digestive tract. During this procedure, samples from suspected areas are taken for biopsy.
- Colonoscopy helps to look for ulcers, tissue inflammation, or any abnormal growth in the colon (large intestine) and rectum. Biopsy samples are also collected during colonoscopy.
- Stool culture may help to exclude the diagnosis of bacterial and parasitic infections.
- Barium swallow or upper GI series is an X-ray examination of the upper gastrointestinal tract with barium contrast to enhance visibility.
- Barium enema or lower GI series helps visualize the rectum and colon with X-ray using barium contrast.
- Capsule endoscopy is an imaging method using a wireless camera. This camera is of a vitamin pill size and passes through the digestive tract. Pictures taken by the capsule are transmitted to a device worn as a waist belt.
- MR or CT enterography can also look for inflammatory changes and complications of Crohn’s
Biopsy samples from colonoscopy and endoscopy are evaluated in the lab. Diagnosis is made if the sample shows tissue changes that are specific to Crohn’s disease.
Ulcerative Colitis VS Crohn’s Disease
Crohn’s disease and ulcerative colitis are types of inflammatory bowel disease (IBD), but they affect different parts of the GI tract. Although some symptoms are common, these diseases have different clinical features (6).
| Crohn’s disease | Ulcerative colitis |
| Affects the entire GI tract from mouth to anus, most commonly involves ileum and colon | It only affects the colon and often rectum |
| Involves all layers (entire thickness) of the bowel wall (transmural inflammation) | It affects the inner lining of the colon (mucosal inflammation) |
| Skip lesions with patches of normal areas on the affected parts | No skip lesions, continuous inflammation is seen |
Treatment For Crohn’s Disease
There is no specific cure for Crohn’s disease. It is a chronic (long-term) condition and usually managed with symptomatic treatments. Crohn’s disease treatment is planned to achieve the following goals (7).
- Relieve symptoms
- Control inflammation
- Maintain adequate nutrition
- Prevent complications
Doctors may plan a treatment regime to meet these goals based on your child’s age and health status. The treatment regime could include:
- Medications, such as steroids, antibiotics, and immune-modulatory drugs, to reduce diarrhea, pain, and inflammation.
- Dietary modifications, such as eliminating spicy, highly fibrous foods and milk. Easily digestible foods are recommended for children with Crohn’s
- Vitamin supplements are given after nutrient analysis to prevent vitamin deficiencies.
- Nutritional supplements, such as high-calorie liquid formulas, are prescribed to manage delayed growth.
- Intravenous (IV) feeding is given if there are requirements of nutrition for a short time.
- Abscess draining and bowel resection are common surgical procedures to manage Crohn’s disease.
- Ostomy is a surgery involving removing part of the intestine and creating an opening in the body to empty the stool. Special bags are attached to this opening to collect stool.
Medications and dietary modifications are initial treatments for Crohn’s disease. Surgical treatments are recommended to manage the symptoms that are not resolved with medications. Bleeding, abscesses, ulcers (sore), perforation, or intestinal obstruction (blockage) may require surgical treatment in some children.
Short bowel syndrome may occur in some children after bowel resection surgery. It usually happens if a large section of the bowel is removed. It may cause malabsorption leading to weight loss, dehydration, and malnutrition. The doctor may prescribe appropriate medications and dietary changes to prevent these complications after surgery.
Dietary Changes For Crohn’s Disease
No special diet has been proven to treat Crohn’s disease. Children could have a reasonably normal diet during the remission period. The following dietary changes may be helpful to ease symptoms in some children (8).
- Drink enough water to stay hydrated
- Add foods with soluble fibers such as bananas, oatmeal, tapioca, rice, and applesauce
- Avoid foods with insoluble fiber, such as nuts and seeds
- Eat frequent meals in small portions
- Avoid foods that triggered symptoms earlier
- Limit milk and other dairy products with lactose if they have lactose intolerance
- Avoid greasy or high-fat foods
- Avoid caffeinated drinks
- Avoid high-sugar foods, such as candies, pies, and cakes
- Avoid gas-producing foods, such as beans, cabbage, and onions
- Avoid foods with artificial sweeteners, such as sorbitol, mannitol, and xylitol, since this may trigger diarrhea; sugar-free chewing gums and beverages commonly contain these compounds
Frequently Asked Questions
1. Does Crohn’s disease shorten the lifespan of kids?
Life expectancy in people with inflammatory bowel disease (IBD, such as Crohn’s disease) was lower than in those without IBD. People with IBD have an increased risk of developing chronic health issues such as heart problems, respiratory disease, arthritis, cancer, kidney and liver problems, which may be the contributing factor. However, this difference has been seen to reduce over the past years with increased life expectancy in these patients (10) (11).
2. At what age is Crohn’s disease usually diagnosed?
Crohn’s disease in children should be discussed with the child’s pediatrician to make dietary changes that suit their needs. Some children with severe malabsorption or short bowel syndrome may also require partial or total parenteral nutrition. However, Crohn’s disease cannot be prevented. Therefore, a healthy diet and medications may help to ease symptoms and prevent flare-ups. It is a chronic condition that may recur during your child’s life. The disease may result in physical, emotional, and social issues. But your endless support and encouragement, together with medical care, can help your child live with it.
Key Pointers
- Crohn’s disease in children is a type of inflammatory bowel syndrome which may affect any part of the digestive tract.
- The disorder is attributed to genetic, immune malfunctions and some medications.
- Some signs and symptoms may include gastrointestinal disturbances, delayed growth, bone pain, and anemia.
- The treatment involves dietary modifications and medications to control inflammation and relieve symptoms.
References
2. Pediatric Crohn’s Disease; The National Organization for Rare Disorders
3. Complications and Extraintestinal Manifestations; Crohn’s and Colitis Canada
4. Overview of Crohn’s Disease; Crohn’s & Colitis Foundation
5. Crohn’s Disease in Children; Lucile Packard Children’s Hospital, Stanford
6. Ulcerative Colitis vs Crohn’s Disease; UCLA Center for Inflammatory Bowel Diseases; University of California, Los Angeles (UCLA) Health System
7. Crohn’s Disease in Children; Cincinnati Children’s Hospital
8. Eating, Diet, & Nutrition for Crohn’s Disease; The National Institute of Diabetes and Digestive and Kidney Diseases
9. Crohn’s disease, ; Harvard Medical School
10. M. Ellen Kuenzig et al.; Life expectancy and health-adjusted life expectancy in people with inflammatory bowel disease; NCBI (2020)
11. Comorbidities. CDC
12. Crohn’s Disease in Children. Lucile Packard Children’s Hospital Stanford
13. Neera Gupta et al.; Presentation and Disease Course in Early- Compared to Later-Onset Pediatric Crohn’s Disease; NCBI (2012)
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