Crohn's disease is one of the group of conditions called inflammatory bowel disease (IBD) in which parts of the digestive system become inflamed. Children with Crohn's disease may be affected anywhere in the digestive system, from the mouth all the way down to the anus and/or rectum. The exact cause of Crohn's is unknown; current medical opinion is that the body's immune system attacks the digestive tract and causes the range of symptoms that are seen in Crohn's disease. Unfortunately, symptoms in children may be present for a long time before a diagnosis is made.
Abdominal Pain
This is a very common symptom of IBD, experienced by the majority of children with Crohn's disease. It may be experienced as a dull aching sensation or sharper, more cramp-like pain. The lower right part of the abdomen is the most common location for pain, because this is where the terminal ileum (the end of the small intestine) is located; the terminal ileum is the most common area to become inflamed. Patients may find that the pain is increased just before a bowel movement, and that having a bowel movement decreases the pain temporarily.
Weight Loss
This common symptom of Crohn's disease is the result of a combination of factors: the fear of eating brought on by the perceived association between food and pain; the lack of appetite brought on by the overall inflammatory process and feeling unwell; and the diarrhea that is also a hallmark of Crohn's disease. Together, these processes result in undesired weight loss may be quite significant.
Diarrhea
Frequent episodes of loose, watery stool may occur either because more fluid is being produced by the inflamed intestine, or because less fluid is able to be absorbed due to the inflammation.
Failure to Grow
This is an especially significant symptom in a child who has Crohn's disease, occurring in about 1/3 of patients who are diagnosed with Crohn's. Growth failure has several definitions; the most straightforward definition is growth less than 5 cm (about 2 inches) per year. In a child with Crohn's disease, this failure to grow at the normal rate occurs primarily due to a loss of appetite and a decrease in the number of calories taken in. Loss of appetite may occur because of certain chemicals that are produced in the intestine of a patient with Crohn's disease or more directly, because parts of the stomach or intestine are inflamed. As a result of the lack of appetite, children will eat less than usual, which also may contribute to the growth failure. Importantly, failure to grow may not be noticed by parents, and may even occur prior to the appearance of other symptoms.
Bleeding
While obvious blood in the stool is not the most common symptom of Crohn's, it may occur if the large intestine is the area that is inflamed. In this case, the inflammatory process leads to ulcerations in the wall of the intestine, which may result in blood in the stool. Rectal bleeding, from small tears called fissures, may also be a symptom in children with Crohn's disease.
Symptoms in the Mouth
Symptoms in the mouth and gums are common in children with Crohn's. Patients may have severe sores in the mouth (ulcers). Alternatively, children may experience pain and inflammation in the gums and mouth. Children with oral symptoms may also develop little flaps of tissue along the inner cheek or along the gums; these are called mucosal tags.
Symptoms Around the Anus
These are quite common in children with Crohn's and include pain around the anus (perianal pain), anal fissures (small cuts in the anus that are painful and may bleed), and anal skin tags (flaps of skin that may drain or be painful).
Extraintestinal Manifestations
This is the term given to any symptoms that occur outside the digestive tract. Common symptoms include a rash called erythema nodosum, which consists of painful bumps that may occur on the legs, back, and abdomen; arthritis, which is inflammation of the joints such as the knees or ankles; and arthralgia, which is the term for joint pain without necessarily having joint inflammation.
References
- "Gastrointestinal Physiology"; Kim Barrett; 2006
- "UpToDate"; Denise Basow; 2009
- "Gastroenterology;" Growth failure in children with inflammatory bowel disease: a prospective study; KJ Motil et. al.; September, 1993
- "Tintinalli's Emergency Medicine: A Comprehensive Study Guide"; Judith E. Tintinalli, MD, MS, et. al.; 2004
- "Current Medical Diagnosis and Treatment"; Stephen J. McPhee, Maxine A. Papadakis; 2010
