Stunting is the most typical, and sneaky, symptom of Crohn’s disease in children.
It’s not just grown-up diseases. Increasingly, Crohn’s disease and ulcerative colitis, chronic inflammatory bowel diseases, are diagnosed in children.
In fact, 20% of cases of Crohn’s disease begin by the age of 20. In Italy there are 100,000 people who are affected and of these about 3,000 are under 18 years old.
Crohn’s disease
It is characterized by chronic inflammation that can affect the entire gastrointestinal tract, from the mouth to the anus, but in most cases affects the last stretch of the small intestine and the colon.
The inflammation can cause narrowing (stenosis), which in turn can cause a partial and total intestinal obstruction, or create a fistula, or an abnormal opening between the intestine and, for example, the skin surface near the anus (in this case we speak of perianal fistula).
Symptoms
The three classic symptoms are:
- diarrhoea, sometimes with blood
- fever around 37.5 ° – 38.5 ° C
- abdominal pain, even cramping.
“In children, up to 18 years, the characteristic symptom, and also the most subtle, is stunting. This is because the inflammatory disease uses calories to support itself, and therefore stops the growth of the child» explains Costantino De Giacomo, Director of the Maternal and Child Department and of the Complex Structure of Pediatrics at the Niguarda Ca ‘Granda Hospital, Milan.
Not all of them have the same signals, or they have only a few. Others may have recurrent canker sores in the mouth or lesions at the perianal level such as fissures or fistulas. Often there are also symptoms of the osteoarticular apparatus such as arthritis, joint pain, ocular manifestations such as conjunctivitis and sometimes skin problems.
“About 25% of cases of Crohn’s disease appear after 10 years of age, but 4-5% are diagnosed by age 5, sometimes even under 2, and predominantly affect the colon. Paediatric diseases are generally more severe and more prone to relapses» continues De Giacomo.
Diagnosis
Laboratory and instrumental tests are required to diagnose Crohn’s disease.
| Laboratory tests | Instrumental examinations |
|---|---|
| Blood tests to measure hemoglobin levels, platelets and some non-specific markers of inflammation such as ESR (erythrocyte sedimentation rate) and CRP (c-reactive protein) | Ileocolonoscopy |
| Stool examination to evaluate fecal calprotectin, which allows to obtain information on intestinal inflammation. |
Therapies
In mild and moderate forms of children, the first choice therapy is nutritional.
“Resting the intestine and feeding it for about two months exclusively with a milk-based mixture has excellent effects in 80% of cases, both on the disease and on growth. The therapy can be repeated, but the results diminish with time» concludes De Giacomo.
To maintain remission of inflammation, immunomodulators are used; in Italy 30% of children are treated with biological drugs.
Surgery is used in case of strictures, fistulas or complications.
In most cases, patients, when properly treated, can control the disease and lead a normal life.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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