Crohn’s disease in children: Diagnosis and treatment

Crohn’s disease is a chronic inflammatory condition that affects the digestive system. Because Crohn’s is characterized by a wide variety of symptoms, it can be tricky to diagnose. Multi-specialty centers, like Le Bonheur, can help when answers are hard to find.

Pediatric Gastroenterologist John Whitworth, MD, director of Le Bonheur’s inflammatory bowel disease (IBD) clinic, answers common questions about Crohn’s Disease.

Q: How early can you diagnose Crohn’s disease?

A: The peak age of diagnosis of Crohn’s disease is 15 to 25 years old. It is not uncommon to make the diagnosis in a pediatric center between ages of 10 and 15 years old. There are much rarer types of Inflammatory Bowel Disease (IBD), including Crohn's disease, that affect children under 6 years and even in infants.

Q: What are the symptoms of Crohn’s in children and teens?

A: The most common symptoms of Crohn’s disease in children include growth problems or weight loss associated with gastrointestinal symptoms like abdominal pain, diarrhea or blood in the stool. Occasionally there are extra-intestinal symptoms including fever, joint pain and skin lesions.

Q: How is Crohn’s diagnosed; are there any special tests?

A: There is no single test to diagnose Crohn’s disease. The diagnosis requires a complete evaluation and interpretation of blood tests, stool studies, upper and lower endoscopies, and x-rays. With this many tests and results it can sometime be difficult to interpret in a child or in a new case. 

Q: How is Crohn’s treated in children? Is it a lifelong disease?

A: Crohn’s disease is a lifelong diagnosis and requires lifelong treatment. Crohn's is currently thought to be caused by an abnormal immune system response to an, as yet, unidentified environmental trigger. Currently there is no known specific dietary trigger. This abnormal immune response can develop in those with a genetic predisposition and Crohn's may be seen in more than one family member. However, a family history is not required to develop Crohn's disease.

A current hypothesis is that the immune response in patients with Crohn’s disease is against normal, good bacteria, which is erroneously perceived by the immune system as being harmful. The treatment of Crohn’s requires medications to reduce the abnormal immune response. This typically requires medications to suppress the immune system by controlled amounts. Treatments come in the form of pills, shots, infusions, enemas and nutritional therapy.