Introduction

Crohn’s disease (CD) is a long-term, chronic condition that causes irritation and swelling in the digestive system, anywhere from the mouth to the anus.¹ The symptoms of the disease are stomach pain, fever, and diarrhoea, often with blood,  mucus or both.² 

While most people are diagnosed in early adulthood, Crohn’s disease is becoming more common in children.¹ Spotting the disease in childhood is important as it can help manage symptoms sooner, prevent health problems and improve long-term outcomes. The purpose of this article, therefore, is to help parents recognise the early warning signs of Crohn’s disease and how to manage them. 

General overview of Crohn’s disease in children

What does Crohn’s disease do to the digestive system?

The exact cause of CD in children is unknown. What is understood is that it may be caused by a variety of  factors, including genetics, the immune system, environmental factors, and a person’s gut bacteria.^3,4

In a healthy gut, the immune system and the intestinal lining work together to keep bacteria and other microbes in the stomach from triggering any irritation that can lead to inflammation. Special cells in the intestine, like Paneth cells, M Cells, and Dendritic cells help monitor the gut environment and only trigger an immune system response when there is perceived harm in the stomach.³

When CD develops, the intestinal barrier is damaged. This means the stomach is unable to tolerate bacteria in the gut, causing a strong inflammatory response in the stomach. The immune system produces large amounts of cytokines, which further damage the gut, leading to symptoms such as stomach pain, fever, and blood in the stool.³

Crohn’s disease in adults vs. children 

CD that begins in children often looks and behaves differently from CD that begins in adulthood. In children, the disease tends to have more severe and widespread symptoms. CD in children is more likely to affect the colon (large intestine) and the upper digestive tract.^5,6 About 40% show symptoms in the upper digestive tract compared to only about 6% in elderly patients.⁶

One key difference is that perianal disease is more common in children than in adults. This may be because in very young children under the age of six, CD tends to primarily affect the colon, whereas in older children, teenagers, and adults, it affects both the small intestine and the colon.⁶

Children with Crohn’s disease are also more likely to suffer from symptoms like diarrhoea, stomach pain, fever, and weight loss, which tend to decrease as the patients get older. In contrast, adult patients suffer more from rectal bleeding.⁶

Crohn’s disease is more aggressive in children. This is because over time, the disease tends to spread to other parts of the digestive system, whereas in adults, the disease location remains stable.⁶ More than half of children diagnosed with CD develop complications, and as a result,  intestinal surgery is common in children than in adults.⁷

Early warning signs parents should watch for

Growth and development symptoms

The first sign of  Crohn’s disease in children is slowed growth. Nearly half of children with Crohn’s disease appear shorter or smaller than their peers of the same age. This symptom is often present even before other digestive symptoms appear.^4,6 Other symptoms to look out for are: 

• Poor weight gain 
• Sudden weight loss
• Delayed growth or puberty compared to peers^6,8

Digestive symptoms

• Pain in the lower right side of the stomach
• Ongoing diarrhea
• Unintended weight loss 
• Bleeding from the rectum or blood in diarrhoea when the disease affects the colon³

Skin, mouth and joint symptoms

It is estimated that about half of Crohn's disease patients experience symptoms outside the digestive system, such as: 

• Mouth ulcers 
• Red, tender skin  
• Joint pains 
• Eye issues³

General symptoms

• Reduction in appetite⁴
• Fatigue and low energy
• High fever 
• Anorexia³

When should symptoms raise concern?

Early detection of Crohn’s disease is very important. The initial symptoms can sometimes go unnoticed because of how subtle they are.⁸ The differences between, for example, a normal stomach bug and persistent CD symptoms can be easy to miss. Regular check-ups are useful for tracking children’s growth over time. Doctors are able to see whether a child is hitting the expected milestones, as slowed growth often appears before digestive symptoms.⁸ As a general rule, it is useful to keep a symptom journal, and when symptoms last beyond a few weeks, seek help from a doctor who can carefully assess the child’s condition.

Importance of medical evaluation for persistent symptoms

A medical check-up distinguishes Crohn’s disease from other digestive problems. Early detection protects a child’s health, growth, and development and helps prevent complications. Therefore, if your child is experiencing any ongoing symptoms, it is important to seek medical help immediately. 

Supporting a child with Crohn’s disease

• CD can have a significant impact on both the child and their parents
• CD has two main aims to control inflammation and any complications that may arise, and to reduce the long-term effects of both the disease and the medications used to treat it¹ 
• The treatment options doctors take are typically based on the patient’s age, symptoms and how widespread the condition is¹ 

The following are some of the treatment options available to children with CD:

General health and follow-up

CD is a long-term disease. As a result, regular follow-up visits to the doctor are important. These can help spot any flare-ups and manage any possible long-term complications.³

Nutritional therapy 

When treating children with CD, nutrition and growth are especially important.⁴ Good nutrition plays an important role in managing CD, especially for children who may experience weight loss and malnutrition as a result of the disease.³ Research has shown that poor nutrition often results in worse disease outcomes and more complications. Therefore, by correcting nutritional deficiencies and supporting a healthy gut balance, children can experience better overall health outcomes, fewer risks and even need fewer medications.⁴

Corticosteroids 

Children with mild to moderate CD are treated with steroids to help control inflammation. Budesonide, a special type of steroid, is used to treat diseases located in the lower part of the small intestine or near the beginning of the large intestine. To treat other areas of the disease stronger steroids like prednisone can be used.³

Surgery 

Sometimes, children with CD may need surgery. This tends to happen when:

• Medicines are no longer working 
• The child cannot tolerate the medication
• The disease causes complications such as abscesses or intestinal blockage 

 In these more severe cases, a team of doctors carefully evaluate the child before recommending surgery. Thanks to advances in medical technology, minimally invasive surgical techniques are often used,  allowing for faster recovery.³

Summary

Crohn’s disease in children is a long-term disease that causes inflammation anywhere in the digestive tract. Unlike adults, children often show early signs like slowed growth, delayed puberty and poor weight gain. These symptoms are then followed by the more common symptoms like stomach pains, diarrhoea, blood in stool, fever, and fatigue. Crohn’s disease is a chronic condition and can flare up at any time. Therefore, it is important that parents are able to recognise the early warning signs and seek medical advice promptly. Children with Crohn’s disease need regular doctor’s visits and a treatment plan tailored to their symptoms. Management of the disease often includes a mixture of nutritional therapies, medications to control inflammation, and sometimes surgery for more severe cases. Emotional and social support is also necessary for both children and parents, as the disease can also affect these aspects of life. With proper care, children with Crohn’s disease can live full lives.