Crohn's Disease in Children

What is Crohn’s disease?

Crohn's disease is a type of inflammatory bowel disease, or IBD. The condition causes chronic inflammation in the digestive system, and it may affect the mouth, esophagus, stomach, small intestine, large intestine and anus. In addition to inflammation, Crohn's disease can also cause abscesses, infections and areas of intestinal narrowing, called strictures. The other main type of IBD is ulcerative colitis, which only affects the large intestine.

IBD is not the same as irritable bowel syndrome. Irritable bowel syndrome is a disorder that affects the muscle contractions of the large intestine. People with irritable bowel syndrome do not experience inflammation in the intestine and do not have damage to the intestinal lining.

What causes Crohn's disease?

The exact cause of Crohn's disease is unknown, but genetic and environmental factors may contribute to the development of the condition. Stress and eating habits can aggravate Crohn's disease, but do not cause it.

According to recent research, the digestive system of people with Crohn's disease seems to mistake harmless bacteria — the kind that digests food — for harmful bacteria it thinks shouldn't be there. When this happens, the body launches an immune system attack. Cells travel out of the blood and into the intestines to produce inflammation, which is typically a good thing. But because the inflammation doesn't go away in people with Crohn's disease, it can lead to ulcers and thickening of the intestinal wall, eventually causing noticeable symptoms.

Who gets Crohn's disease?

Crohn's disease may affect as many as 1.4 million Americans, and males and females are equally likely to be affected. The disease can occur at any age, but it is most common among adolescents and young adults between the ages of 12 and 35.

Research suggests Crohn's disease can be hereditary, which means there is an increased chance of developing the disease if a parent or sibling also has it.

A genetic predisposition for Crohn's disease has been identified in people of eastern European backgrounds, including people who are Jewish and of European descent. A different genetic predisposition has been reported among African Americans.

What are the signs and symptoms of Crohn's disease in kids?

Crohn's disease can affect any part of the digestive system. Symptoms may depend on the affected area. While symptoms vary from patient to patient and some may be more common than others, symptoms of Crohn's disease in children can include:

Persistent diarrhea
Rectal bleeding/bloody diarrhea
Urgent need to poop
Abdominal cramps and chronic pain
Sensation of incomplete poops

Other general symptoms of Crohn's disease in children can include:

Fever
Loss of appetite
Weight loss or poor weight gain
Delay in puberty
Tiredness
Night sweats
Loss of normal menstrual cycle
Recurrent mouth sores
Achy or swollen joints

Crohn's disease symptoms may come and go, and patients may experience extended periods without symptoms, called remission. Remission can last for months or years, although symptoms will likely return at some point.

Crohn's disease can lead to chronic anal fissures, which are small tears in the inner lining of the rectum that can cause infections around the anus. Crohn's disease can also cause small tunnels in the intestines called fistulas. These tunnels emerge from the intestine to connect to other loops of intestine and can lead to further problems. Fistulas can be painful and may require evaluation.

Other organs may also be affected by Crohn's disease, including the skin, eyes, joints, bones, liver and bile ducts.

What tests are used to diagnose Crohn's disease?

An accurate diagnosis of Crohn's disease typically requires multiple tests, including a review of medical history and a physical examination to check height, weight, eyes, ears, mouth, heart and lungs, as well as the abdominal and anal regions. Additional tests may include:

Upper intestinal endoscopy and colonoscopy with biopsies: a procedure using a thin tube with a lighted camera on the end to view the lining of your child's digestive system; we take a tissue sample, or biopsy, for lab testing
Blood tests: a sample of your child's blood is used to identify inflammatory markers, liver and kidney function, protein stores, iron and vitamin D levels, and sometimes other important minerals, that could support diagnosis of Crohn's disease
Stool test: a sample of your child's poop helps us rule out infection and allows us to assess for inflammation
MR enterography (a type of magnetic resonance imaging, or MRI), CT enterography or upper gastrointestinal small bowel: these imaging techniques produce detailed pictures of your child's digestive system
Video capsule endoscopy: a "camera pill" that captures internal images of your child’s digestive system

Why choose us for evaluation and treatment of Crohn's disease?

At Children's Hospital Colorado, our Pediatric Inflammatory Bowel Disease Center specializes in the diagnosis of Crohn's disease in children under 18. That's important because kids are not the same as adults. Their vital signs and test results look different. How they are growing and developing is very important. Our experts know that, and it allows them to quickly identify abnormalities that may indicate Crohn's disease.

What to expect from Crohn's disease tests?

Hospital visits can be scary for kids, especially if a series of tests is required. We've found that kids prefer a more creative and interactive evaluation and treatment approach. Here, we take the time to help your child understand what the test is and why it's important. We also give them an opportunity to ask questions. When your child takes on an active role, they relax and naturally become curious. This helps the evaluation process to move smoothly.

How is Crohn's disease treated?

We can help treat your child's Crohn's disease in a variety of ways. The treatment methods we recommend can depend on the severity of your child's condition. The main goal of treatment is to help your child live as normally as possible.

Medication is the most common method of treatment. There are several kinds of medication, and we’ll recommend the one that best fits your child's needs. Crohn's disease is a chronic condition, which means your child will likely need to stay on the medication throughout adulthood.

Nutrition is another effective treatment method for Crohn's disease. A nutrient-rich diet with enough protein, calories and healthy fats can help control your child's symptoms. Registered dietitians with our Clinical Nutrition Department help patients and families learn to manage special diets.

In addition to more traditional treatment approaches, our digestive specialists perform research and participate in clinical trials to evaluate new treatments and help define new therapies to treat Crohn's disease in children.

Why choose us for treatment of Crohn's disease?

Our Pediatric Inflammatory Bowel Disease Center, part of our nationally-ranked Digestive Health Institute, is the only center of its kind in the region to provide multidisciplinary care for kids with Crohn's disease. This means our team includes specialists from multiple areas of medicine, including:

Board-certified pediatric gastroenterologists
Advanced practice nurses
Nurse coordinators
Clinical social workers
Registered dietitians
Pediatric radiologists
Pediatric surgeons
Psychologists
Child life specialists

This team works together to provide comprehensive and seamless care for your child, from the initial diagnosis to treatment to your child's eventual transition to adult medical care. Our innovative approach to the treatment of Crohn's disease and our participation in the ImproveCareNow collaborative, means we are equipped to provide you, your child and your family with the information and skills you need to manage the condition long term.

Learn even more about how we treat Crohn's disease in children and teens.

What's the difference between Crohn's disease and ulcerative colitis?

Crohn's disease can affect any part of the digestive system. Ulcerative colitis only affects the large intestine.

Helpful resources

The Crohn's and Colitis Foundation offers information and community support programs for patients and their families, as well as a summer camp experience called Camp Oasis.
Take Steps is a fundraising and advocacy group for ulcerative colitis and Crohn's disease.
GIKids.org provides useful educational material and links.