A Look at Pediatric Inflammatory Bowel Disease (IBD)

Hope Trachtenberg-Fifer, RN, MS

Although people of all ages are diagnosed with IBD, most cases are diagnosed before the age of 30, and of those, most are diagnosed during adolescence. In fact, IBD has become one of the most significant chronic diseases affecting children and adolescents.

IBD is not new to pediatrics; the first patient Dr. Burrell Crohn and his associates described having regional enteritis, which is now known as Crohn’s disease, was a 16-year-old boy.

It is estimated that 10% of patients with inflamma­tory bowel disease (IBD) are under the age of 18 years; another 10% of children are diagnosed when they are less than 5 years of age. The disease, in the form of either Crohn’s disease (CD) or ulcerative colitis (UC), can be seen as early as the first month of life. In infants, UC is seen more frequently; how­ever, the peak years of pediatric onset of IBD are in early adolescence, when CD is more common.

The diagnosis of IBD in children is not necessarily dif­ficult if there is chronic diarrhea and bleeding, but if there are other presentations, such as flares of joint pain, diarrhea with no blood, chronic anal fissure, or poor growth without other symptoms, then the diagnosis may be confusing, or even overlooked. Blood tests, endoscopy, pathologic findings on biopsy, and imaging are all used to help make the diagnosis, just as in adults.

Both Crohn’s and ulcerative colitis tend to strike during childhood at an average age of 12 years old. And, just as in adult inflammatory bowel disease, pediatric IBD runs the spectrum from mild to severe disease.

Malnutrition and weight loss can be significant problems in IBD. This is especially so in pediatric IBD. Particularly when presenting in childhood or adolescence, the first noticeable symptoms of the disease can be poor growth and weight loss. Children can actually present with a slow down in growth, having fallen several percentiles on the growth curve, while suffering minimal intestinal complaints. Therefore, growth failure can be the major presenting symptom in pediatric IBD, with insignificant GI manifestations. It believed that a pediatric IBD patient has probably had undiagnosed IBD for about 2 years before clinical symptoms are such that they are questionable, and the child is diagnosed.

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