Treatments for Inflammatory Bowel Disease in Children

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Contact the Inflammatory Bowel Disease Center

  • 1-617-355-6058
  • International: +01-617-355-5209
What are the treatments for inflammatory bowel disease in children?

Many parents are concerned when their child is diagnosed with a chronic illness, and understandably so. No parents want their child to be unwell. But IBD is very treatable, and with consistent health care and a good understanding of the condition, the vast majority of people with IBD go on to live full and active lives. You and your child are in excellent hands at Boston Children's Hospital.

Depending on the severity of symptoms, treating IBD disease often requires a combination of approaches, especially at first:

1. First diagnosed with IBD

Most of the time, children are having severe symptoms when they are first diagnosed. If your child feels unwell, the first thing we will do is get her symptoms under control as quickly as possible.

During this time, you and your child will meet with members of your child's IBD team, all of whom have expertise in working with children with IBD and their families. Besides your child's primary gastroenterologist, you may talk with:

  • a nurse specialist
  • a social worker
  • a registered dietician
  • a nurse educator

2. Managing IBD

There are many different ways to manage IBD, and your clinician may use any number of the following courses:

  • Changes to your child’s diet, working in concert with a dietitian to design a balanced nutrition program for your child
  • Course of maintenance medicine
  • Anti-inflammatory medications may help with abdominal pain and diarrhea
  • If your child has a more severe case of IBD, we may prescribe more steroids, antibiotics, or drugs that suppress the immune system (immunosuppressants). 
    • It may take a while to figure out which medications work the best for your child. While IBD is a lifelong condition, our goal is to keep it in remission for as long as possible – meaning a “normal” life for your child, with few to no symptoms.

3. Dealing with flare-ups of IBD

Flare-ups are when your child again begins to experience symptoms of IBD, or feeling especially tired and unwell. If your child is having a flare-up, we'll treat it with rescue medicines – a short course of strong medications. We'll also monitor her closely to determine what may have caused it and whether any changes should be made to her treatment plan.

What are common medications for inflammatory bowel disease?

This is a brief summary of some of the medications used for IBD. Please discuss specific medications – and your child's individual situation - with your doctor.

Corticosteroids, including:

  • Budesonide (Entocort®)
  • Prednisone/Prednisolone
  • Benefits
    • Reduces inflammation and relieves diarrhea, rectal bleeding, fever, and pain in both forms of IBD.
    • May relieve “systemic” symptoms like joint pain, skin and eye lesions.
  • Precautions
    • Fluid retention, facial “mooning”, weight gain, acne, hair loss and sleeplessness are some side effects.  More serious side effects may occur.
    • Side effects usually disappear when you stop taking the drug.  Do not stop taking this medication unless you have talked with your doctor.
    • Take with food to help with stomach upset.

Aminosalicylates, including:

  • Mesalamine (Asacol®, Canasa®, Rowasa®, Pentasa®)
  • Sulfasalazine (Azulfidine®)
  • Benefits
    • Reduces inflammation in mild to moderate ulcerative colitis and Crohn's colitis or ileocolitis.
    • In ulcerative colitis, it may prevent relapse.
  • Precautions
    • Occasional dizziness, headache, nausea, vomiting are side effects.  
    • Take with food to help with stomach upset.
    • Be sure to drink lots of fluids.
    • May cause lowered sperm count which is reversible when medicine is stopped.
    • May increase your risk of developing pericarditis (fluid around your heart), pancreatitis (inflammation of your pancreas), and worsening of your colitis.
    • Sulfasalazine may discolor your skin (orange-yellow) and may increase your risk of sunburn (be sure to use sunblock).

Immunosuppressors, including:

  • Cyclosporine (Neoral®, Sandimmune®)
  • Tacrolimus (Prograf®, FK-506®)
  • 6-mercaptopurine (6-MP®, Imuran®, azathioprine®)
  • Benefits
    • In both forms of IBD, may allow for gradual decrease of your steroid medicine.
  • Precautions
    • May cause decrease in white blood cells and platelets.
    • Rare side effects include nausea, fever, rash, pancreatitis, and hepatitis.
    • May slightly increase your risk of developing lymphoma.
    • Do not take these medications with grapefruit juice.
    • Do not take these medications if pregnant.
Antirheumatics, including:

  • Infleximab (Remicade®)
  • Adalimumab (Humira®)
  • Benefits
    • Decrease in the number of draining entero-cutaneous fistulas.
    • May treat refractory ulcerative colitis.
  • Precautions
    • Side effects may include dry mouth, metallic taste, tongue or mouth irritation, upset stomach, dizziness, vomiting, diarrhea, loss of appetite, numbness, dark brown or reddish urine.
    • Do not drink alcohol – may result in severe nausea and vomiting.

Antiulcer/H2 blockers, including:

  • Ranitidine (Zantac®)
  • Benefits
    • Decreases the amount of acid made in the stomach.  
    • Treats stomach ulcers, heartburn and stomach irritation.
  • Precautions
    • May cause headaches, constipation, upset stomach, stomach pain, dizziness, fever and diarrhea.
    • Liquid form contains alcohol.

What if surgery is recommended to treat my child’s IBD?

While we almost always start treatment for IBD with medication, sometimes a child may not respond (or stop responding) to medications, and be a good candidate for surgery. The decision to have surgery is a joint one, made between your child, your family, your child's gastroenterologist and the surgeon.

Learn more about specific surgeries for Crohn’s disease and ulcerative colitis.

What are follow-up treatments like for my child with inflammatory bowel disease?

Lifelong follow-up is crucial with IBD, since it allows your child's doctors to:

  • make sure her medication is working
  • check for side effects of the medication
  • monitor your child for appropriate levels of growth
  • use blood tests to make sure your child's blood chemistry is as it should be
We also recommend bone scans (to monitor bone density and prevent bone weakening) and eye exams.

How often will my child with inflammatory bowel disease need follow-up appointments?

This depends on your child, her treatment plan and how she is feeling. If your child is doing very well, and experiencing few to no symptoms, your child's doctor may want to see her every six months. If your child is on immunosuppressant medications, there's a higher risk of complications, and we'd like to see her every three months. If your child is not feeling well, she will come in every four weeks or so.

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- Sandra L. Fenwick, President and CEO

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