Introduction

Crohn’s disease (CD) is an inflammatory bowel disease (IBD) and a long-term condition that causes inflammation in the digestive tract. However, the cause of CD is unknown.

About 20–25% of people with IBD are children under 18, and most of these are teenagers. The number of children diagnosed with CD is rising, with approximately 2.5 to 11 out of every 100,000 children diagnosed each year.¹ 

In general, CD pathology in children is similar to adult cases; however, there are differences in symptom presentation, treatment, and surgery approaches of the pediatric patient. Some children develop the disease very early, before age 6, or even before age 2. In these cases, the disease often affects the colon and does not respond well to standard treatments.² These young patients could need special testing and alternative treatment approaches.

Corticosteroids (steroids) are one of the treatment options used to treat CD. They can work quickly to decrease inflammation; however, their side effects are especially risky for children, as they can affect growth and development.³

This article will explain the benefits and risks of steroid treatment for children with Crohn’s disease and offer practical advice and guidance for parents.

What are corticosteroids?

Corticosteroids, often just called steroids, are hormones normally made by the adrenal glands, small organs sitting on top of the kidneys.⁴ In medicine, when people say “corticosteroids,” they usually mean glucocorticoids, which are a type of steroid that play a key role in controlling inflammation.

Glucocorticoids are naturally present in the body and play a very important role in managing stress, regulating metabolism, supporting brain function, and controlling inflammation, which is important for CD.⁴ Doctors use corticosteroids to treat a wide range of conditions, from asthma and allergies to autoimmune diseases, such as rheumatoid arthritis, multiple sclerosis, and inflammatory bowel disease. 

While steroids can be incredibly effective at reducing inflammation quickly, they have serious side effects.⁴ High doses or long-term use can cause weak bones (osteoporosis), slowed growth in children, weight gain, high blood pressure, diabetes, eye problems including glaucoma or cataracts, skin thinning, and a higher risk of infections.⁴ 

These are the commonly used corticosteroids in crohn’s disease

• Prednisone, or prednisolone, is very effective; however, it carries a higher risk of side effects
• Budesonide is not as strong as prednisone; however, it has fewer side effects. Budesonide releases the medicine in specific parts of the gut (the ileum and the right side of the colon).⁵ Budesonide MMX (the newer generation) are designed to deliver the medicine throughout the colon
• Hydrocortisone, methylprednisolone, and dexamethasone are used in intravenous infusion⁶ 

Benefits of corticosteroids in children with crohn’s disease

When a child with CD has a moderate or severe flare-up, doctors often turn to corticosteroids as the first line of treatment. These medicines work quickly to reduce inflammation and bring symptoms under control; this is called induction therapy – a short-term “rescue” treatment that helps a patient feel better fast.⁵ The fast reduction of symptoms is important for a child’s social life, allowing them to return to school, friends, and daily life. 

However, corticosteroids are not meant for long-term use. Usually, once symptoms improve, doctors reduce the dose and then stop the corticosteroid treatment and switch to a long-term treatment, such as immunomodulators or biologic medicines that can safely keep the disease under control.⁵

Risks and side effects of corticosteroid treatment

Despite their effectiveness, corticosteroids can come with side effects, some of which are mild and come and go quickly, while others can appear after some time and be harmful.⁵

Short-term side effects could include

• Mood swings or irritability
• Trouble sleeping (insomnia)
• Increased appetite and weight gain
• A higher risk of infections

Long-term risks could include

• Slowed growth and delayed puberty
• Weaker bones (osteopenia or osteoporosis)
• Changes in appearance, such as a rounded face
• Anxiety or depression

Additionally, there is a condition called steroid dependency, where some children find it difficult to taper off steroids without symptoms returning, which increases the risk of relapse.

There are several approaches to reduce the risks of corticosteroids⁷

• Using corticosteroids only for short-term induction, not long-term maintenance
• Increasing use of long-term treatment like immunomodulators, biologics
• Using nutrition-based therapy (exclusive enteral nutrition as an alternative in children)
• Monitoring regularly the following parameters: growth charts, bone density, and psychological support

What parents should know

Corticosteroids are not the enemy; they can be lifesaving and irreplaceable during flare-ups. The key to using corticosteroids is careful management. 

It’s helpful to discuss corticosteroid treatment with the gastroenterologist and make sure that the treatment plan is clear and everyone is on the same page. If you notice some negative effects, sometimes switching to a different corticosteroid can make a difference. Additionally, you could ask about alternative treatment and long-term plans.

At home, keep an eye on your child’s growth, mood, and any side effects, and share these observations with the doctor. 

Summary

Corticosteroids are an important treatment tool for managing Crohn’s disease in children, especially during flare-ups when there is a requirement for quick symptom relief. However, because of their side effects, they should be used carefully and only under a doctor’s supervision.

The safest approach is short-term use, with close monitoring and a clear plan to transition to other medications that can keep the disease under control in the long run.