Inflammatory bowel disorder in children

Summary: Inflammatory Bowel Disease (IBD), including Crohn’s and ulcerative colitis, causes persistent inflammation of the gastrointestinal tract. It leads to symptoms like stomach pain, frequent bowel movements, and impaired growth. Diagnosis involves tests and endoscopy, while treatment involves medications, nutritional management, and sometimes surgery. When children receive timely intervention and support, they can better manage their symptoms and maintain good health.    

Inflammatory Bowel Disease (IBD) refers to a group of long-term digestive disorders marked by chronic inflammation in the gastrointestinal tract. The most prevalent forms are Crohn’s disease and ulcerative colitis, both of which can affect paediatric populations. IRecent studies indicate a rising incidence of paediatric IBD in Australia, particularly Crohn's disease, aligning with global trends. These disorders may cause severe symptoms and complications, potentially interfering with a child’s physical growth, development, and overall well-being. Understanding the causes, symptoms, and treatment approaches for IBD in children is crucial for effective care and better health outcomes.  

What is Inflammatory bowel disease (IBD)

What are the first signs of IBD in children?

• Abdominal pain 
• Diarrhoea 
• Fatigue 
• Loss of appetite 
• Weight loss 
• Poor growth 
• Joint pain or swelling 
• Fever 
• Blood in stool 

Also read: What are the symptoms of an IBS flare-up? A doctor’s guide 

How is inflammatory bowel disease diagnosed in children?

• Medical history and physical exam: The doctor begins by reviewing symptoms, family history, and physical signs of IBD. 
• Blood tests: Blood tests assist in identifying signs of inflammation or anemia, which are often observed in IBD. These tests can also detect nutritional deficiencies, dehydration, and signs of infection.  
• Stool tests: Stool tests are conducted to exclude infections or other gut conditions that could cause similar symptoms, like bacteria, viruses, or parasites.  
• Endoscopy and colonoscopy: These are important diagnostic tools. A colonoscopy uses a flexible tube with a camera to inspect the large intestine and rectum. For Crohn’s disease, doctors may use an upper endoscopy or capsule endoscopy to view the small intestine. During these procedures, the doctor may obtain biopsies (tissue samples) to confirm the diagnosis. 
• Imaging tests: Imaging techniques like X-rays, CT scans, or MRIs may be used to visualise the gastrointestinal tract, detect swelling, and check for complications like strictures (narrowing of the intestines) or abscess formation.  

Types of IBD

Crohn’s disease:

Ulcerative colitis:

Indeterminate colitis:

Recognising the various forms of IBD in children—Crohn’s disease, ulcerative colitis, and indeterminate colitis is crucial for prompt diagnosis and effective treatment. Although managing these conditions can be demanding, with appropriate medical care and support, most children can control their symptoms and enjoy active, healthy lives. 

Also read: Irritable Bowel Syndrome (IBS) symptoms: 12 foods to avoid 

Causes

• Genetics: Children with a family history of IBD have a higher likelihood of developing the condition. Specific genes may render a child more prone to abnormal immune reactions in the gut. 
• Immune system response: IBD may develop when the immune system incorrectly attacks healthy cells in the digestive tract, perceiving them as threats. This persistent immune response culminates in inflammation and damage over time. 
• Environmental factors: Elements such as diet, gut microbiota, infections, and exposure to certain medications (like antibiotics during early childhood) may contribute to triggering IBD, particularly in genetically predisposed children. While these factors do not directly cause the illness, they may influence its initiation or exacerbations. 

Diagnosis

1. Medical history and physical exam: The doctor will start by inquiring about the child’s symptoms, growth trends, a family history of IBD, and any prior health concerns. A physical examination can help detect abdominal tenderness, growth delays, or weight loss. 
2. Blood and stool tests: Blood tests can indicate inflammation, anemia, or nutritional deficiencies. Stool samples are frequently analysed to exclude infections and assess for inflammation in the digestive tract. 
3. Endoscopy and colonoscopy: These techniques enable doctors to directly visualise the interior of the digestive tract using a thin, flexible tube fitted with a camera. They can also obtain small tissue samples (biopsies) to confirm inflammation and differentiate between Crohn’s disease and ulcerative colitis. 
4. Imaging tests: Additional imaging techniques, like MRI or ultrasound, may be utilised to investigate areas of the digestive system that are more difficult to access or to identify complications such as fistulas or abscesses, which occur more frequently in Crohn’s disease.   

Home treatments

• Diet and nutrition: A properly balanced diet is vital for children with IBD. Certain foods might provoke flare-ups, so recognising and avoiding these triggers is essential. Collaborating with a dietitian can help develop a nutrition plan that guarantees sufficient calorie intake, especially if the child is facing weight loss or delays in growth. In some instances, specialised diets or nutritional supplements may be advised.   
• Hydration: Maintaining hydration is vital, particularly during flare-ups when diarrhoea may lead to dehydration. Encourage the child to consume plenty of water and fluids rich in electrolytes to sustain adequate hydration levels.   
• Rest and stress management: Ensuring enough rest and minimising stress can play a role in managing IBD symptoms. Stress is known to exacerbate flare-ups, so discovering ways to relax and de-stress, such as through hobbies, mindfulness practices, or gentle exercise, can be advantageous.   
• Probiotics and supplements: Some parents may consider using probiotics and other supplements to promote gut health. Probiotics could help balance gut bacteria and alleviate symptoms in some children. However, it's important to consult a healthcare professional before introducing new supplements to confirm their safety and effectiveness.   
• Monitoring symptoms: Keeping a symptom diary can aid parents in tracking flare-ups and identifying potential triggers. Observing changes in appetite, stool consistency, abdominal discomfort, or growth can assist healthcare providers in adjusting treatment plans as needed.   

Impact on growth and development

1. Physical growth: Children with IBD, particularly those with Crohn’s disease, may undergo delays or slowed growth due to the malabsorption of crucial nutrients. This can lead to weight loss, hindered height growth, or postponed puberty. If not addressed, these growth delays may have lasting consequences on a child's physical development.   
2. Bone health: Prolonged inflammation from IBD, along with the use of medications such as steroids, can contribute to weaker bones or osteoporosis. Ensuring sufficient calcium and vitamin D intake, coupled with regular physical activity, can help safeguard bone health during treatment.   
3. Psychosocial impact: The emotional and psychological ramifications of IBD should not be overlooked. Children with chronic illnesses may face stress, anxiety, or depression associated with their symptoms or the lifestyle adjustments they need to make. The difficulties of managing a chronic condition can also influence social interactions and academic performance. 
4. Developmental milestones: Children with IBD may sometimes struggle to achieve specific developmental milestones, such as success in school or social integration, due to the physical and emotional hurdles they encounter. Early intervention with appropriate support systems can assist them in keeping pace with their peers. 

When to consult a GP

How can telehealth with an online doctor help?

Telehealth with an online doctor offers several benefits for children with IBD and their families. It allows for convenient access to medical consultations without travel, making it particularly beneficial for those in remote locations or families with hectic schedules. Online consultations can assist with initial assessments, follow-up visits, and continuous management of treatment plans. During video calls, doctors can discuss symptoms, track progress, and modify the treatment plan as necessary. Telehealth also guarantees privacy and convenience, allowing families to consult healthcare providers from their own homes. 

In addition, online doctors can give advice on symptom management, provide referrals to specialists, provide online scripts or valid medical certificates and help parents monitor their child’s health, especially when in-person visits are not immediately feasible. 

In summary, IBD in children is a chronic condition that may influence a child’s health, growth, and day-to-day functioning. However, with early diagnosis, proper treatment, and consistent support from families and healthcare providers, most children can manage their symptoms and live active, healthy lives.