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Pediatric Crohn's DiseaseOverviewCrohn's disease (CD) is one of two common types of inflammatory bowel disease (IBD) that affect approximately 1.4 million Americans. It is estimated that some 140,000 children suffer from Crohn's disease and a related illness, ulcerative colitis (UC). In fact, some 25% of IBD patients develop these diseases as children or teenagers.
Crohn's disease causes the inner surface of the intestine to become raw, eroded and inflamed. The chronic illness can affect any part of a child's gastrointestinal (GI) tract, from the mouth to the rectum, and even the skin outside the anal opening. However, the areas most often affected are the lower part of the small intestine (ileum) and the large intestine (colon).
CausesCrohn's disease is associated with abnormalities in the immune system. Children with Crohn's disease have a disruption in the normal balance of their immune systems that causes the body to attack its own digestive system.
While the cause of Crohn's disease is not yet known, researchers believe that an environmental factor (which has yet to be identified) triggers the abnormal immune response in genetically susceptible individuals. Scientists continue to examine several key factors, including the immune system, viral or bacterial infections, diet and genetic predisposition.
DiagnosisDiagnosis of pediatric Crohn's disease can be difficult. Various tests, including blood tests, stool studies, endoscopy (sometimes with biopsy), imaging studies (x-ray, computed tomography (CT), MRI) can help physicians to exclude other causes of the inflammation and confirm a diagnosis of Crohn's disease.
SymptomsPersistent diarrhea, abdominal pain, rectal bleeding, fever, and weight loss are the hallmarks of Crohn's disease in both adults and children. Symptoms may appear gradually or develop very suddenly.
Abdominal pain and diarrhea are often the earliest signs, while lack of appetite, weight loss, and slowed growth are also common. In fact, in some children, nonspecific weight loss or slowed growth may be the initial symptoms of the disease. Other signs of Crohn's disease include sores in the anal area, extra folds of skin around the anal opening, and anal fistulas (tiny openings or pores from which pus-like fluid can seep).
Complications: Stunted GrowthWhen Crohn's disease is diagnosed before puberty, children may experience delayed or stunted growth. Signs of growth failure include a lower-than-expected increase in height and weight. Other signs of growth failure are delayed bone development (which can be measured by X-ray) and an onset of puberty that appears delayed compared with the family pattern. Children with Crohn's disease may be aware that they are shorter than most of their classmates and parents may notice that the size of a child's clothing and shoes remains the same for a long period of time.
Emotional ImpactDealing with a chronic condition like Crohn's disease can be difficult for children and adolescents as they move through this period of physical and emotional growth and development. The often debilitating symptoms of Crohn's, including a lack of growth and significant weight loss, can have a tremendous impact on a child's social functioning and even their self-concepts. Children with CD may suffer with anxiety, depression, sheer denial of the chronic condition or even a lack of independence.
When a child's emotional responses to Crohn's disease interfere with his or her ability to function emotionally, it can also have an impact on the entire family. It is important to recognize and address not only the physical but also the emotional impact that Crohn's disease can have on a child and his or her family's life.
TreatmentCurrently, there is no cure for Crohn's disease. The two basic goals of treatment for children with Crohn's disease are to achieve and maintain remission (the absence of symptoms).
There is no "one-size-fits-all" treatment for every child or adolescent with Crohn's disease. The treatment approach must be tailored to the individual because each child's disease is different. Five different categories of drugs are used in IBD: - Aminosalicylates (5-ASA-based drugs)
- Corticosteroids
- Immunomodulators such as azathioprine, 6-mercaptopurine or cyclosporine
- Antibiotics
- Biologics
SurgeriesSurgery may be necessary for children with Crohn's disease when medication no longer controls their symptoms. It also may be called for when there is an intestinal obstruction or other complication that cannot be managed by medication. In most cases, an irreversibly diseased segment of bowel is removed, and the two ends of healthy bowel are joined together. This is called resection and anastomosis. While this surgery may allow for many symptom-free years, it is not considered a cure, as the disease may recur at or near the site of anastomosis.
* All information compiled from CCFA's "A Guide for Parents" and "Crohn's Disease and Ulcerative Colitis: Emotional Factors." Date Posted: July 24, 2006
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