Crohn’s disease is a chronic inflammatory bowel disease that affects part of the gastrointestinal tract starting from mouth to anus.

Crohn’s disease diagnosed in children and adolescents below 18 years old. The inflammation is patchy which affects some areas and leave others area unaffected.

This inflammation can cause:

Ulceration that breaks in the lining of the GI tract.

Strictures are narrow in the bowel due to scar tissue.

Fistulas are abnormal connections between the bowel and other organs.

Pediatric Crohn’s disease shows challenges due to lack of trials and psychological issues in children.

Address these issues with medical solutions for better health outcomes and growth.

Family history of IBD increases risk due to genetic component. Specific genes including NOD2/ CARD15 plays important role.

Global increase in IBD occurrence with 20% to30% of US cases diagnosed in childhood. North

America’s rate for children aged between 10 to 19 years old is around 3.5 cases per 100000.

Crohn disease peaks in the second and third decade of life with a smaller peak in adults 60 to 80 years old.

Crohn disease rates are higher in women, while pediatric IBD is more common in boys than girls.

Their prevalence is higher in Whites than Blacks, while it is rare in Asians and Hispanics.

T-cell activation causes chronic inflammation and tissue injury due to defective regulation of helper lymphocytes type 1. Cytokine-recruited cells release substances that injure the intestine.

Crohn disease causes skipped inflammation in upper/lower GI tract, while ulcerative colitis results in continuous colonic inflammation.

Intestinal mucosal biopsy in Crohn’s shows chronic inflammation with architectural distortion.

Crohn disease results from combined genetic and environmental factors trigger immune response and chronic intestine inflammation.

The causes of Pediatric Crohn Disease are:

Genetics

Immune System Dysfunction

Environmental Factors

Microbiome Imbalance

Death from Crohn disease is rare in young people. Severe cases can lead to hospitalization, surgeries, growth and nutrition problems.

Pediatric Crohn’s disease requires early intervention to manage symptoms and reduce complications.

Ileocolonic Crohn’s disease has a more aggressive course and higher complication rates than isolated small bowel.

Poor growth or failure to indicates severe disease and complications due to chronic inflammation and malabsorption.

Clinical History:

Collect details including presenting symptoms, family and medical history to understand clinical history of patient.

Abdominal Examination

Perianal Examination

Joint Examination

Growth and Puberty Assessment

Acute symptoms are:

Severe Abdominal Pain

Persistent Diarrhea

Fever

Vomiting, abdominal distension

Constipation

Chronic symptoms are:

Mild to moderate abdominal pain

Intermittent diarrhea, fatigue, and weight loss

Growth Failure

Therapy for pediatric Crohn disease starts with 5-aminosalicylic acid, antibiotics, and nutritional therapy for mild cases.

Corticosteroid and immunomodulatory therapy with 6-MP or MTX are attempted if no response or severe disease.

Patients and families often use alternative therapies. Potential benefits seen with omega-3 fatty acids in fish oil.

Metronidazole and combination of metronidazole with ciprofloxacin are effective for perianal, small bowel, and colonic disease management.

Nutritional therapy is important in treating disease, malnutrition, growth failure in Crohn’s.

MTX effectively induces to maintain remission in adult Crohn’s disease, and it is well tolerated for pediatric remission maintenance.

Administer infliximab IV 5 mg/kg at weeks 0, 2, 6, then every 8 weeks for maintenance in clinical practice.

Pediatrics, General

Keep environment clean and limited exposure to potential infectious agents is required.

Nutritional counselling plays vital role in recovery process of patient as it promotes the nutritional diet.

To deal with fatigue and stress issues patient should follow occupational or physical therapy which is useful to manage fatigue and maintain functional stability.

Proper awareness about Pediatric Crohn Disease should be provided and its related causes with management strategies.

Appointments with a pediatrician and preventing recurrence of disorder is an ongoing life-long effort.

Pediatrics, General

Mesalamine:

It inhibits leukotriene biosynthesis through the lipoxygenase pathway of arachidonic acid metabolism.

Pediatrics, General

Hydrocortisone:

It decreases inflammation to stabilize leukocyte lysosomal membranes of destructive acid hydrolases.

Methylprednisolone:

It prevents inflammation to control rate of protein synthesis at cellular level

Pediatrics, General

6-Mercaptopurine:

It interferes with protein synthesis and nucleic acid metabolism.

Azathioprine:

It decreases the proliferation of immune cells, which lowers autoimmune activity.

Methotrexate:

It impairs DNA synthesis to reduce production of interleukin (IL)-1.

Pediatrics, General

Infliximab:

It reduces infiltration of inflammatory cells and TNF-α production in inflamed areas.

Pediatrics, General

Metronidazole:

It is an intermediate metabolized compounds that inhibit protein synthesis to cause cell death.

Pediatrics, General

These intervention procedures are used by physicians:

Endoscopic Procedures

Imaging Techniques

Perianal Interventions

Surgical Procedures

Pediatrics, General

In the initial assessment phase, evaluation of patient history, physical examination, and laboratory test to confirm diagnosis.

Pharmacologic therapy is effective in the treatment phase as it includes use of corticosteroids, immunosuppressants, and monoclonal antibodies.

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.

The regular follow-up visits with the pediatrician are scheduled to check the improvement of patients along with treatment response.