Treating Children

According to the Crohn’s and Colitis Foundation of America, Crohn’s disease affects more than half a million Americans. Most are diagnosed with the condition during their 20s and 30s, but some begin showing symptoms during childhood and adolescence. Approximately 20 percent of all cases of Crohn’s disease occur in children.

What is Crohn’s disease?

Crohn’s disease is an inflammatory bowel disease that causes swelling of the lining of the gastrointestinal tract, affecting the ability to digest food properly. The inflammation can result in symptoms, including:

  • abdominal cramps
  • excessive diarrhea
  • rectal bleeding
  • fevers
  • fatigue
  • a loss of appetite

Many children are still going through puberty when they’re diagnosed. This disease can potentially stunt growth and weaken bones.

Trying to juggle school and daily tasks with unexpected Crohn’s flare-ups can be a challenge for children. There are treatments that can help your child manage their symptoms and cope with the effects of their condition.

Treating Crohn's disease in children

For young people dealing with Crohn’s disease, it’s critical to find a treatment that lessens symptoms without causing harmful side effects. Some medications can be more dangerous for children specifically. For instance, infliximab (Remicade) is often used to treat Crohn’s disease in adults.

Infliximab may be effective in treating adults, but it has been found to cause hepatosplenic T-cell lymphoma in some children, especially in those also taking certain other Crohn’s medications. This is a rare type of cancer that can be life-threatening. However, Remicade has recently been approved by the FDA to treat children with moderate to severe Crohn’s disease who haven’t responded well to other treatments. Your child’s doctor will help you weigh the risks and benefits of this or any other treatments.

Talk to your child’s doctor about which medications would be best for easing your child’s symptoms. There are various medicines that can help your child without causing serious negative effects. Surgery is sometimes needed when medical treatments fail to control your child’s symptoms.

Common medical treatments

Aminosalicylates

Some of the preferred medications for treating Crohn’s disease in children are aminosalicylates (5-ASAs). These are a group of medicines that can reduce inflammation in the gastrointestinal tract. Since inflammation often triggers the onset of Crohn’s disease symptoms, 5-ASAs can help prevent flare-ups.

However, these medications do have potential side effects, which include headaches, abdominal cramping, and gas. In rare cases, children taking 5-ASAs experience hair loss and skin rashes. The medications might also increase the risk of swelling around the heart, lungs, and pancreas.

Antibiotics

Antibiotics are another type of medication that may be used to treat children with Crohn’s disease. Common antibiotics for Crohn’s include metronidazole and ciprofloxacin, which are both prescribed in lighter doses for children. These medications work by suppressing inflammation in the gastrointestinal tract, helping to reduce the recurrence of symptoms.

Each antibiotic comes with its own set of possible side effects. Metronidazole may cause nausea, vomiting, and loss of appetite. When used for an extended period, the medication can also cause a tingling sensation in the hands and feet. Ciprofloxacin may cause headaches, rash, and diarrhea, and in rare cases may cause tendonitis and rupture of the tendons.

Steroids

Steroids in the form of corticosteroids may also be prescribed for some children with Crohn’s disease.

These medications can cause uncomfortable side effects, so they’re rarely the preferred option for long-term treatment. Corticosteroids may cause the following side effects in children:

  • acne
  • facial swelling
  • weight gain
  • unwelcome hair growth
  • mood swings
  • personality changes
  • high blood pressure

These side effects usually disappear when the doctor lowers the dosage or takes the child off corticosteroids.

Immunosuppressors

Immunosuppressors, or medications that suppress the immune system, such as azathioprine or 6-mercaptopurine, may be used to help wean off or reduce the use of corticosteroids.

These medications may cause side effects such as:

  • nausea
  • a fever
  • a rash
  • inflammation of the liver or pancreas
  • a reduction in white blood cells and platelets in the blood

Immunosuppressors may increase the risk of developing lymphoma.

Treating Crohn's in children through nutrition

Diet

If you’re wary of the potential side effects of most medications, managing your child’s symptoms through diet and nutrition may be the best option. To help prevent flare-ups, you should avoid giving your child certain foods that may exacerbate symptoms, including spicy foods, beans, and possibly dairy products.

While many cases of Crohn’s disease are too severe to be managed through diet alone, ensuring that your child has a well-balanced diet can help reduce symptoms. Make sure they’re eating enough lean protein, fruit, and vegetables. It’s also important for your child to eat foods containing soluble fiber, such as applesauce, blueberries, and oatmeal. Your child may also need to take calcium supplements if they have weak bones as a result of Crohn’s disease. Other vitamin and mineral supplements are often also recommended.

Exclusive enteral nutrition

Some families have successfully tried exclusive enteral nutrition (EEN), which involves the exclusive use of special liquid formulas that help fight inflammation. Many children have found the formulas unpalatable, so they often need to be administered through a feeding tube inserted through the nose, stomach, or rarely, a vein.

While this is a safe method of combating the effects of Crohn’s disease, it can take a significant amount of time, making it inconvenient for many families. Talk to your child’s doctor to see if EEN may be a good choice for your family. 

You asked, we answered

  • What is the outlook for children with Crohn’s disease?
  • Since Crohn’s disease is a chronic disease, it’s important to maintain good follow-up with doctors throughout your child’s life. Your child will likely have periods of remissions and flares, which are often unpredictable. However, by working with your child’s doctors, you should be able to find a treatment plan that manages your child’s symptoms and limits negative effects. Research is underway looking at new treatment options which are more effective, safer, and may eventually produce long-lasting or even permanent remissions.

    - Laura Marusinec, MD