It can be crushing to see your child endure a chronic condition that still mystifies the medical community. Still, with the right tools and information, you can help your child lead a full, normal life. The landscape has shifted recently, with advances in research opening new avenues for child-friendly, gentle and natural ways of managing Crohn’s.
The better you understand the condition and new treatment options, the more empowered you’ll be to make informed decisions on behalf of your child.
What is Crohn’s Disease
Crohn’s disease (CD) is one of two inflammatory bowel diseases (IBD). The condition is driven by chronic inflammation in the lining of the small intestine (the ileum) and the colon.
The inflammation along the digestive tract leads to diarrhea, abdominal pain, weight loss, malnutrition, and fatigue. In children, these symptoms can cause complications like weakened bones, stunted growth, and delayed puberty.
Symptoms of Crohn’s disease in children and teens
Crohn’s disease is characterized by periods of remission, in which symptoms are not active, and periods of flare-ups, in which symptoms emerge and become more severe.
The symptoms of Crohn’s disease can vary, but they commonly include:
- Persistent diarrhea (sometimes bloody)
- Rectal bleeding
- Abdominal pain
- Weight loss
- Fever
- Delayed growth
- Joint pain
- Rashes
- Perianal disease (can include abscesses near the anus or fistulas, which are inflammatory tracts that may discharge mucus at the skin near the anus)
What causes Crohn’s disease in children and teens
Researchers are not yet able to confirm the exact cause of Crohn’s disease, but IBD is thought to develop from an interaction between genetics, immune dysregulation, environmental factors, and potentially gut bacteria composition (an imbalance between healthy and pathogenic gut bacteria).
Immune Dysregulation
Crohn’s disease can develop from a dysregulated immune response. This happens when the immune system fails to shut off after responding to a threat, and mistakenly targets the gastrointestinal system. This is the cause of chronic intestinal inflammation and the main symptoms of Crohn’s.
Genetic Predisposition to Crohn’s disease
Children may have a higher risk of developing Crohn’s disease if they:
- Have a family member with Crohn’s disease
- Have a family history of Crohn’s disease
- Are of Caucasian and Ashkenazi Jewish descent
Researchers have identified many gene mutations associated with Crohn’s disease. Carrying such a mutation slightly increases the risk of developing Crohn’s. For example, a mutated gene in the interleukin 10 signaling pathways. Interleukin 10 is a cytokine meant to regulate and inhibit inflammation, but mutated genes can disturb this regulation, leading to severe inflammation in the digestive tract.
However, many who carry a mutation never develop Crohn’s, and some Crohn’s patients have no identifiable gene mutation, so having a genetic disposition does not necessarily mean someone will develop Crohn’s. Rather the risk of development appears to increase when other factors are involved.
Environmental Factors
‘Environmental factors’ refers to the impact of one’s physical environment, lifestyle, and diet. For instance, studies show that children who live in urban, industrialized areas and in northern climates are more at risk of developing CD than other populations.
There is substantial evidence that a ‘Westernized’ diet may increase the risk of developing Crohn’s disease. This means a diet rich in fat, red meat, and refined, highly processed food. Early consumption of soft drinks is also associated with a greater risk.
Additionally, research shows that within Western populations, there is an increased risk of IBD from large quantities of antibiotics taken during childhood.
Gut Bacteria & Microbiome
Studies on the gut microbiome show that an imbalance or lack of diversity in the composition of our gut bacteria may increase the risk of IBD. Although this is not yet fully understood, IBD patients statistically show lower gut bacteria diversity than other populations, and this has become a proposed target for novel treatments.
How is Crohn’s disease diagnosed in children?
First, the doctor will rule out any other potential cause behind the symptoms. After a standard physical exam and discussion regarding your family history, the doctor will likely run lab tests on your child’s blood and stool.
Doctors request stool tests to see if blood loss has occurred and to detect a protein called calprotectin. Calprotectin in the stool is a biomarker for mucosal inflammation which could indicate the presence of Crohn’s disease or other inflammatory gut disorders. It also helps measure the level of inflammation throughout treatment.
Other diagnostic procedures include:
- Imaging: The patient drinks a contrast dye and has an X-ray, CT Enterography or MRI Enterography.
- Capsule endoscopy: The patient swallows a capsule with a tiny camera in it. The capsule travels through the small intestine and transmits images before being expelled through a bowel movement. The FDA has approved this for children over 10 years old.
- Colonoscopy: The doctor will use a small camera at the end of a lighted tube to examine the interior of the colon while the child is asleep under general anesthesia.
- Upper endoscopy: The doctor will use a tube that runs from the mouth into the stomach and the first part of the small intestine or duodenum. This is also done under general anesthesia.
When to see a doctor
You should take your child to the doctor if they experience any long-term:
- Belly pain
- Loose stools
- Fever
Treatment for Crohn’s Disease in Children and Teens
There are several paths you can take for managing pediatric Crohn’s disease, with both natural and conventional treatment options available. Your child may require attention and support from various specialists, depending on their specific needs and symptoms.
Discuss treatment options thoroughly with your child’s doctor, especially regarding the side effects of medication.
Nutritional Support of Crohn’s disease in children
Nutritional support is crucial, as Crohn’s makes it difficult for the body to absorb important vitamins and minerals. The most common nutritional deficiencies for Crohn’s are:
- Iron
- B12, B6 & B1
- Vitamin D
- Vitamin K
- Folic acid
- Selenium
- Zinc
A registered dietitian will help tailor a nutrition plan and determine foods that trigger inflammation. Not only that, but certain diets can actually help manage symptoms up to the point of remission, so it’s highly worth exploring diet as a therapy with your child’s healthcare team.
Diet: An Effective Therapy for Pediatric Crohn’s Disease
Recent evidence supports diet and nutrition as a potential sole therapeutic treatment for Crohn’s disease in children, especially with mild-moderate disease. In particular, the Crohn’s Disease Exclusion Diet (CDED) was found to sustain remission and induce mucosal healing in children with mild-to-moderate Crohn’s.
The CDED was developed as a patient-friendly, sustainable diet designed to reduce food that negatively impacts the microbiome, intestinal barrier, and immune system. The whole-food diet emphasizes unprocessed foods, allowing fruits, vegetables, chicken, eggs, rice, and potatoes. It’s also packed with beneficial fibers, and combined with liquid formulas for extra protein and calcium. One of the benefits of CDED for children is that it’s not terribly limiting, with a wider variety of foods being introduced every 6 weeks after the initial induction phase.
Supplements for Pediatric Crohn’s Disease
Of all the supplements under clinical trial for IBD, curcumin currently has the most evidence to support its use as an induction and maintenance therapy for Crohn’s disease.
Curcumin is the active compound extracted from the rhizome of turmeric. A natural anti-inflammatory and antioxidant agent, curcumin works through a broad range of mechanisms to reduce or regulate inflammatory cytokines and pathways behind the symptoms of IBD and has been found to positively impact the gut microbiome.
Curcumin has tested well for safety and efficacy in children with IBD. Of note, a 2013 study on children with Crohn’s disease found curcumin to be well tolerated in all patients, with improvements in the Pediatric Crohn’s Disease Activity Index (PCDAI), specifically abdominal pain, daily bowel movements, perianal symptoms, and general wellbeing. A 2015 study also found that some IBD patients taking curcumin for induction therapy showed complete mucosal healing after just 4 weeks.
Medication for Pediatric Crohn’s Disease
The aim of most treatments for Crohn’s disease is to reduce symptoms and inflammation so that the damaged tissue can heal.
- Immunomodulators modify the response of the immune system (ex, 6-mercaptopurine, azathioprine and methotrexate).
- Biologics are antibodies produced from living organisms that tune down an overactive immune response (ex, infliximab or adalimumab)
Corticosteroid drugs are a less preferred option, as they cause adverse effects in children and adults, and their use is usually restricted to several weeks or up to a few months to reduce the risk of long-term effects.
Complications
Children with Crohn’s disease may struggle with weight loss if they cannot consume enough calories, whether from pain during digestion, difficulties absorbing nutrients, or having extra nutritional needs due to the disease itself.
In this case, it’s highly advised to work with a nutritionist or registered dietician who can assist with nutritional supplements or high-calorie liquid formulas. These may help with delayed growth, also a complication of CD in childhood.
Other complications to watch out for include:
- A blocked intestine
- Fistulas (tracts of inflammation with discharge to the skin, mostly near the anus)
- Fissures (painful rips or tears in the anus)
- Liver function problems
- Arthritis (pain and swelling of the joints)
- Gallstones
- Anemia
- Bone weakness
- Restless leg syndrome
The long-term outlook for a child with Crohn’s
Although Crohn’s disease is a long-term condition, the symptoms will not always be active. Still, your child’s diet, lifestyle, and specific needs will likely require more attention than usual. It’s best to check your child’s health often to ensure their nutritional needs are being met, as well as to check for infections, bone mineral density, and any possible liver, eye, or skin issues.
In terms of diet, the best option is to work closely with a dietitian to tailor a plan for your child and determine their trigger foods. In general, it’s recommended to avoid processed, greasy or high-fiber foods, and sweets (as much as possible).
High fiber (vegetables and fruits) are usually recommended as part of a more natural and less processed daily diet for Crohn’s, but should be restricted during very active disease, especially if there is a known or suspected narrowing of the intestine (stricture), where high-fiber intake moving as a bulk in the intestine can get ‘stuck’ and exacerbate intestinal blockage at the narrowing).
Evinature
