Crohn's Disease and Ulcerative Colitis in Children and Teens
Children with Crohn's disease, ulcerative colitis, or indeterminate colitis are treated at Duke by a team of experts who collaborate to treat all forms of inflammatory bowel disease (IBD). We work with you and your child to reduce or eliminate symptoms and to ensure proper nutrition so that your child has healthy growth and can take part in everyday activities.
Diagnosing Inflammatory Bowel Disease in Children
Inflammatory bowel disease is an autoimmune condition that causes inflammation in the small intestine, colon (large intestine), stomach, and other areas of the digestive tract. Symptoms can vary and may include frequent stomach pain, diarrhea, bloody stool, and weight loss.
It is important to get an accurate diagnosis for your child, as treatments can differ for Crohn’s disease and ulcerative/indeterminate colitis. Making a diagnosis is like putting together a puzzle. Different pieces -- symptoms, lab work, imaging tests -- help us build a complete picture of your child’s IBD.
We first evaluate your child’s symptoms and perform a physical exam. If inflammatory bowel disease is suspected, your child will be tested for:
- Elevated inflammatory markers
- Low protein levels
- Vitamin/nutrient deficiencies (vitamin B12, folate, vitamin D, zinc, iron)
Other diagnostic tests and exams include:
- Stool samples, to rule out other conditions such as gastroenteritis
- Upper endoscopy or colonoscopy, to check for chronic inflammation in the digestive tract
- CT enterography, a CT scan of the abdomen and pelvis with special contrast to highlight the bowel for inflammation
- MR enterography, an MRI of the abdomen and pelvis with special contrast to highlight the bowel for inflammation
Our pediatric gastroenterologists are actively involved in research to learn more about inflammatory bowel disease. Duke Children’s is also a member of Improve Care Now, a group of more than 100 pediatric gastroenterology centers around the world dedicated to improving the care of children with IBD.
Our team of pediatric gastroenterologists, nurses, dietitians, social workers, and mental health specialists work together to address the physical and emotional aspects of your child’s illness.
INFLAMMATORY BOWEL DISEASE IN CHILDREN
Inflammatory bowel diseases are chronic, lifelong conditions. While there is no cure, many effective treatments are available. Most treatment plans include long-term anti-inflammatory and/or immune suppressant medication. Treatments can improve your child’s quality of life and restore his or her health.
Crohn's disease medications include:
- Corticosteroids, such as prednisolone, prednisone, and budesonide, may be prescribed first to reduce inflammation. They are used for short periods of time, to reduce the risk of long-term side effects.
- Immune suppressants, such as azathioprine, 6-mercaptopurine, and methotrexate, are used in uncomplicated forms of Crohn's disease to maintain remission of mild-to-moderate disease. They suppress an overactive immune system to heal inflammation.
- Biologic treatments, such as such as infliximab, adalimumab, certolizumab, vedolizumab, or ustekinumab, are anti-inflammatory agents that treat inflammation in children with moderate-to-severe Crohn’s disease or forms of Crohn’s disease complicated by fistulas and/or strictures. They are given by injection or by intravenous infusion.
Ulcerative colitis medications include:
- Anti-inflammatory mesalamine treatments, for mild-to-moderate forms of ulcerative colitis, can be taken by mouth or by rectum as a suppository or enema.
- Immune suppressants, such as azathioprine, 6-mercaptopurine, and methotrexate, treat moderate-to-severe forms of ulcerative colitis.
- Biologic agents, such as infliximab, adalimumab, golimumab, or vedolizumab, may also be given for moderate-to-severe cases of ulcerative colitis.
Children with certain forms of Crohn's disease may be treated with exclusive or partial enteral nutrition therapy, which replaces regular food with liquid nutritional formulas. Both forms are given for six to 12 weeks. Your child can drink the formula by mouth or it can be given through a nasogastric tube placed through the nose and into the stomach. Enteral nutrition therapy can help avoid the need for steroids or other medicines and their side effects. Nutrition therapy can restore growth, but some children may experience diarrhea in the early stages of treatment.
Inflammatory bowel disease is a chronic condition, and regular follow-up care is important. Even if your child is feeling well, they should still be seen by their doctor at least once or twice a year. After an initial diagnosis, most children visit with our pediatric gastroenterologists frequently until their condition is in remission. Our team will perform lab tests and X-rays as needed. After your child is in remission, we will see them every two to six months, depending on their condition. Your child’s doctor will perform a physical examination and will assess growth and development. Lab tests are used to ensure the disease is under control and to monitor side effects.
INFLAMMATORY BOWEL DISEASE IN CHILDREN
Living with and managing an inflammatory bowel disease can be exhausting and overwhelming. When you come to Duke Children’s for your child’s care, our team is here to help. Our doctors and nurses will connect your child and you to additional services to answer your questions and provide the extra support you need.
Duke's Adolescents Transitioning to Leadership and Success (ATLAS) Program helps teenagers prepare to be young adults living with inflammatory bowel disease. Teens are paired with college students from Duke University. These older students are living successful lives with IBD, and they serve as mentors to the teens. Mentors share advice about going to college, managing medicines, how to get help when you need it, and even issues around dating. Adolescents participating in ATLAS who are departing for college are given the opportunity to spend a weekend on campus to practice self-management skills with program mentors.
These sessions give newly diagnosed families an opportunity to speak with and interact with families who have been living with inflammatory bowel conditions for a long time. We can pair your family with others who will share their experiences with you, thanks to our partnerships with Improve Care Now and the Crohn's and Colitis Foundation.
Our child life specialists provide support, education, and guidance to help you and your child during treatment and hospitalization. Child life specialists explain procedures, offer encouragement, and use fun activities to take your child’s mind off treatment.
Our social workers can help you navigate the medical system and coordinate the variety of health services your child needs. We help you work with insurance providers, connect you with resources, and help you manage details related to your child’s care.
If your child is staying at Duke Children’s, you can relax in the Ronald McDonald House Family Room. You can grab a light meal, shower, do laundry, or use a computer with internet access.