Inflammatory bowel disease (IBD) is a chronic inflammatory condition affecting the digestive tract. There are several types of inflammatory bowel disease, but most common among these are Crohn’s disease and ulcerative colitis. It’s estimated that around 1.6 million people in the United States are living with some form of inflammatory bowel disease. Of these people, one in ten is below the age of 18. One in four was diagnosed before age 20. When inflammatory bowel disease occurs in children, it’s sometimes referred to as pediatric IBD.
Not all of the symptoms of inflammatory bowel disease in children are the same as in adults.
The traditional symptoms of inflammatory bowel disease are diarrhea, pain and cramping, blood in the stool, fevers, and weight loss. Even the joints, skin, and eyes can be affected by inflammatory bowel disease. Additionally, the two most widespread types of inflammatory bowel disease can have slightly different symptoms. For instance, Crohn’s disease can result in nausea, vomiting, and bloating, indicative of intestinal blockages. Ulcerative colitis can, in its most rare and severe form, cause acute pain, profuse diarrhea, and inability to eat.
These symptoms can all manifest in children with inflammatory bowel disease, but they’re not the only potential signs of this disease. The Pediatric IBD Consortium explains, stating:
“Children with Pedi IBD are not small adults with IBD. Children with Pedi IBD often come to their doctors with different symptoms than adults with IBD. One of the most important issues that need to be addressed specifically in children with IBD is a lack of growth. Because childhood is a time when nutrition has the most significant impact on growth, if a child is not getting enough calories and nutrients, they will not grow and develop at a normal and healthy rate.”
Even if a child is diagnosed with inflammatory bowel disease, it can be difficult to differentiate between Crohn’s disease and ulcerative colitis. This is particularly true if the child is less than five years old. In this case, he or she may be diagnosed with indeterminate colitis.
The number of children with inflammatory bowel disease seems to be on the rise.
In 1991, the incidence of children with inflammatory bowel disease was 1.1 out of every 100,000 children. By 2002, that had risen to 2.4 out of every 100,000 children. Today some sources suggest that the incidence of inflammatory bowel disease may be as much as seven out of every 100,000 children.
In addition to the apparently rising incidence of inflammatory bowel disease among children, there may be an increased number of children with this disease being hospitalized. One study looked at hospitalization records of over 11 million patients, all of whom were age 20 or younger, and identified the patients who were discharged with a diagnosis of inflammatory bowel disease.
It was found that over the last decade, the number of discharged children with Crohn’s disease has increased 59%. The number of discharged children with ulcerative colitis has increased 71%. However, the study did not examine the children’s initial reason for hospitalization. The researchers did not differentiate between children who were admitted for reasons related to their inflammatory bowel disease and children who were admitted for unrelated medical issues; both groups are included in the statistics.
Children with inflammatory bowel disease may face slightly different challenges than adults with the disease.
As noted above, lack of growth can be a serious issue in children with inflammatory bowel disease. In fact, one in three children with Crohn’s disease and one in ten children with ulcerative colitis fail to reach their expected adult height because of their inflammatory bowel disease.
Also, children with inflammatory bowel disease are at risk of low bone mineral density, which significantly increases the risk of osteoporosis and fractures later in life. In a study of 144 children with inflammatory bowel disease between the ages of six and 19, one-half of the study participants had low bone mineral density. Another study found that as compared to children without inflammatory bowel disease, children with the disease have aerobic fitness levels that are 25% lower and muscle function that is 10% lower.
The best way to keep children with inflammatory bowel disease healthy is to diagnose and treat them as early as possible.
One study found that the average time from initial symptoms to diagnosis is four to six months. Unfortunately, this means that the inflammation that characterizes this disease will likely have spread more. The authors of this particular study suggest that more stringent diagnostic evaluation guidelines should be implemented to shorten the time to diagnosis.
The importance of early diagnosis and treatment might be illustrated in a study published in IBD Journal. Researchers found that black children with Crohn’s disease had a 1.5 times higher hospital readmission frequency as compared to white children with the same disease. Black children in this study were also more likely to have vitamin D deficiencies and anemia, as well as more likely to require endoscopic procedures and blood product transfusions. Steroids and biologic agents were also more likely to be used in treatment for black children, which suggests a more severe disease course.
According to one of the study’s authors, it’s possible that these differences between black and white children with Crohn’s disease could be related to intrinsic worse disease in black children. There are, certainly, some diseases which present more severely in black individuals than in white.
However, the study also found that black children tended to be from households with a lower median income. Black children were also slightly older than white children at their first hospital admission. This suggests that it’s possible the difference in disease severity might be due to delayed diagnosis or treatment, or to impaired access to care.
By following their physicians’ orders, children with inflammatory bowel disease can manage their disease and continue to live life fully.
To stay healthy and happy, children with inflammatory bowel disease should:
- Take all medications exactly as prescribed
- Eat a healthy, physician-approved diet
- Stay active as much as possible
- Have an emergency kit on hand with clean clothes, wipes, etc.
- Have a support system of friends, family, and medical professionals
- Remember that most people with inflammatory bowel disease are healthy more often than they are sick
Do you know a child with inflammatory bowel disease?
Image by tamckile via Flickr