Like type 2 diabetes, Crohn's disease once was thought to be an adult illness. Not anymore. Children and adolescents are also plagued with this disease that plays havoc on the digestive tract.
The Crohn’s & Colitis Foundation of America recently hosted a program, Pediatric Crohn’s: Finding the Right Path to Care.
One of the featured presentations was given by a nationally recognized leader in the field - Sandra C. Kim, M.D., a pediatric gastroenterologist at the University of North Carolina who specializes in Crohn's disease in children.
What is Crohn's disease and how does it affect kids
Crohn's disease (CD) is a chronic - recurring - inflammatory bowel disease that affects the entire gastrointestinal tract. That means the disease can cause problems anywhere from the mouth to the anus.
Symptoms include diarrhea, abdominal cramping and pain, ulcers, blood in the stool, loss of appetite and weight loss.
In younger children the disease most often shows up in the colon and causes colitis - inflammation of the colon. Dr. Kim explains:
- It generally appears in teens around the age of 15 and young adults by age 30.
- An estimated 10-25+ percent of all CD cases develop in kids before the age of 18.
- CD is becoming more common as a pediatric illness.
How CD is different in children
CD presents differently in children than it does in adults and has to be treated differently, according to Dr. Kim.
While there are similarities in the symptoms of the disease, onset of the disease is usually more severe in children. This means that the CD causes more severe reactions in the fistulas - abnormal connections between the intestine and other parts of the intestine or skin. These problems are very difficult to treat, and medications often are not enough "to quiet down the more severe flares," Dr. Kim said.
CD in children also progresses more quickly, leading to surgery to remove blocked and infected areas sooner than in adult patients.
In addition to treating the disease itself, special care needs to be given to preventing the disease from interfering with a child's growth and bone health. Therefore, nutrition plays an especially important role in children.
The immediate goal of treatment is to calm the inflammation, and overall goals include preventing future flares, restoring and maintaining normal growth, bone health and nutritional status.
As an ultimate goal, Dr. said, treatment "has to improve the quality of life."
Treating childhood CD
Medications currently on the market have been designed for adults. And few clinical trials have involved children, although that is changing.
"Depending on the age of the child versus the teen, there are some medications that are more easily taken than others, and we have to take that all into consideration."
It's important, Dr. Kim says, for parents to work carefully with healthcare providers to weigh all the risks and benefits of any medication and other treatment options being considered. She also recommends that caregivers spend time researching CD and its treatments, using the resources of such groups as the the Crohn’s & Colitis Foundation of America
Protecting the child's overall health
Dr. Kim explained, "Children with Crohn’s often have decreased bone densities which increase your risk for getting things like fractures, and that’s really bad because I know the kids that I take care of are very active and athletic, and we encourage that, and we want to keep them safe and be able to do those activities.
In addition to dietary deficiencies, inflammation can cause bones to be weaker. Bone density can be boosted by eating calcium-rich foods, supplementing vitamin D and staying active.
Dr. Kim says it's really important to "catch kids by their mid-teen years because this is when you maximize how you strengthen your bones as you accumulate calcium and other minerals in your bones to make them strong."
CD can also impact a child's growth. Dr. Kim says these problems appear before and after the diagnosis. For this reason, again it's important that the disease be controlled before children enter puberty so that their adult health isn't affected.
Puberty can also be affected by CD. Dr. Kim says it's particularly important that children be evaluated at this time to ensure they're doing well both medically and psychologically. If necessary, other healthcare professionals can be called in to work with the youngster.
Finally, nutrition must be a main area of focus for children with CD because the illness can lead to malnutrition and growth issues. Dr. Kim says, “Diet is the food you eat daily. Nutrition is how your body uses it."
With that in mind, Dr. Kim counsels her patients to make wise food choices that the body can fully absorb. During flares, children need more calories because of the inflammation and diarrhea, even though they often don't feel like eating anything.
Dr. Kim concludes, "You just want good nutrition so you can work hand-in-hand with the medications and make them more effective. You can have better healing, hopefully; boost the energy level so that improves quality of life. Often with right choices, you can prevent or help minimize some of the GI symptoms associated with the flare," Dr. Kim said.
This program also included a presentation by Janis Arnold, a clinical social worker at the Center of Inflammatory Bowel Diseases at Children’s Hospital in Boston, who discussed the psychosocial issues children with Crohn's. dailyRx will cover that in a future article.
What you can do now
If your child suffers from this illness, you will want to work closely with a healthcare team to develop and maintain a treatment plan that works best for your child growing up with Crohn's disease.