Crohn's Disease in Children

Crohn’s disease is a form of inflammatory bowel disease (IBD) in which one or more parts of a child’s intestinal tract become inflamed. Crohn’s disease is a chronic but highly manageable disease.

While Crohn’s is more commonly diagnosed in young adults, it does affect children as well. Some important facts about Crohn’s in children and teens:

• Symptoms of Crohn’s may be mild or severe.
• Crohn’s often affects the small intestine, but can affect any part of the digestive tract, including the mouth, esophagus, stomach, duodenum, appendix, colon, or anus.
• There is no cure, however, the right treatment plan can minimize or eliminate Crohn’s disease symptoms with medication and lifestyle changes.
• The disease can go into long periods of remission, for months to even years.
• In rare cases, it starts with orofacial granulomatosis (OFG), a chronic inflammatory condition of the mouth highly associated with Crohn’s that often progresses to the bowel.

While Crohn’s disease symptoms may affect each child differently, common symptoms include unexplained fevers and diarrhea with or without blood. A child may be losing weight and not growing as expected, since the pain may make them not want to eat, and inflammation may prevent the small intestine from absorbing the nutrients the body needs.

Other signs of Crohn’s disease may include:

• Abdominal pain, often in the lower right area
• Weakness
• Fatigue
• Rectal bleeding (although often associated with ulcerative colitis)
• Blood in the stools or black, tar-like stools
• Joint pain
• Rashes

Some infections can cause symptoms like these, and it’s important for these to be excluded as possible causes. Crohn’s can be a challenging disease for a child to have, and reassurance and support can go a long way toward making a child feel better.

Scientists have not yet discovered the cause of Crohn’s disease, but it’s an area of active research. Both genes and the environment play a role. The immune system is also involved, which is why treatment for Crohn’s disease often involves medication to reduce its activity.

There isn’t just one test for Crohn’s disease. Your child’s doctor will most likely recommend a combination of tests to diagnose Crohn’s disease, including:

• Blood tests
• Stool sample tests
• Endoscopy
• Colonoscopy
• Biopsy
• Imaging studies

At Boston Children’s Inflammatory Bowel Disease Center, our team of specialists develops a personalized treatment plan for every patient, based on factors such as specific symptoms, health needs, age and the severity of Crohn’s disease.

Treatment of Crohn’s disease may include:

Medication

Drug therapy is the gold standard treatment for Crohn’s disease in children. It can reduce inflammation, control symptoms and allow the body to properly absorb nutrients again. Crohn’s disease medications can include:

• Anti-inflammatory drugs to bring the disease under control
• Immune system suppressants that can reduce the swelling that causes Crohn’s
• Antibiotics to treat related complications, such as abscesses or fistulas
• Antiulcer/H2 blockers (acid-reducing medications) to treat related ulcers and irritation
• Disease modifying antirheumatic drugs (DMARDs) to slow or halt the underlying causes of inflammation

Nutrition support

Your child will have the option to meet with a registered dietitian who specializes in working with children and teens with IBD and can develop an eating plan to help control symptoms of Crohn’s disease and improve overall health.

Surgery for Crohn’s disease

Sometimes a child may not respond (or stop responding) to Crohn’s disease medications and may be a good candidate for surgery — a procedure that removes a section of the intestine. The decision to have surgery is a joint one, made between your child, your family, your child's gastroenterologist and the surgeon.

It's important to remember that with Crohn's disease, surgery is rarely a cure, since inflammation may recur in other locations throughout the digestive tract. The purpose of surgery is to keep your child feeling well and to minimize the damage done to the intestine.

The dedicated team of clinicians in the Inflammatory Bowel Disease Center includes pediatric gastroenterologists, surgeons, radiologists, nurses and nurse practitioners, registered dietitians, and social workers. These experts provide a range of services and support for children and teenagers living with Crohn's disease, including:

• Second opinions
• Management of IBD in school, work, or social situations
• Management of medications
• Nutritional counseling
• Growth and development monitoring
• Surgical care when necessary

As a leading referral center for pediatric IBD, the center is committed to discovering the causes of, and improving the treatments for, Crohn’s disease in children. We care for children with Crohn’s disease in Boston and at our many locations in Massachusetts.