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About Crohn's Disease

Crohns Disease in Children

Crohn’s disease in children can come in a form of redness, and (inflammation), and can cause sores in the digestive tract. 

Crohn’s disease is a long-term condition. It may flare up in children at different times in your child’s life. In most cases, it affects the small intestine, but more often the lower part of the colon called the ileum. Both the small and large intestines can get affected by the condition.

Sometimes the inflammation may affect the whole digestive tract. This includes the mouth, (esophagus), the stomach, the first part of the small intestine (duodenum), the appendix, and the anus.

Experts don’t know what causes Crohn’s disease. It may be that a virus or bacteria affects the body’s infection-fighting system (immune system). The immune system may have an abnormal inflammation reaction in the intestinal wall that doesn’t stop.

Most children with Crohn’s disease have an abnormal immune system. But doctors don’t really know if Childs immune system is the problem that causes the disease.

Which children are at risk for Crohn’s disease?

Crohn’s disease may affect children of any age. It most often affects people ages 15 to 35. But Crohn’s may also occur in young children. It affects both males and females equally.

Children or teens may be more at risk for Crohn’s disease if they

Have a family history of Crohn’s disease. In most cases, this is a close relative such as a parent, sister, or brother.

What are the symptoms of Crohn’s disease in children?

Each child’s symptoms may vary. Symptoms may include:

stomach pain, often in the lower right area.

1.Loose stool (diarrhea), sometimes bloody.

2.Rectal bleeding and sores.

3.Weight loss and poor appetite 

4.Fever and sweets.

6.Joint pain, flu-like symptoms

7.A cut or tear in the anus (anal fissure)

8.Rashes on the skin.

Some children may have no symptoms for years and may stay in remission for years.

The symptoms of Crohn’s disease may look like other health problems. Always see your child’s doctor for a diagnosis.

How is Crohn’s disease diagnosed in a child?

Your child may be checked for signs of Crohn’s disease if he or she has had long-term:

1.stomach pain.

2.Loose stools 

3.Fever

4. A loss of healthy red blood cells, This can make your child feel tired.

Your child’s doctor will take a health history and do a physical exam. Other tests for Crohn’s disease may include blood tests. These are done to see if your child has fewer healthy red blood cells because of blood loss. These tests also check if your child has a higher number of white blood cells. That might mean there is an inflammation problem. Other blood tests can look for abnormal antibodies. The doctor may use this result to help diagnose or clarify the disease.

1.Stool culture. This is done to see if an infection by a parasite or bacteria is causing the symptoms.

2.Endoscopy. This test checks the inside of part of the digestive tract. It uses a small, flexible tube called an endoscope. The tube has a light and a camera lens at the end. Tissue samples or biopsies from inside the digestive tract may also be taken for testing.

3.Colonoscopy. This test looks at the full length of the large intestine. It can help check for abnormal growths, inflamed tissue, sores or ulcers, and bleeding. It uses a long, flexible, lighted tube called a colonoscope. The tube is put into your child’s rectum up into the colon. This tube lets the doctor see the lining of the colon and take out a tissue sample or biopsy to test it. Your child’s doctor may also be able to treat some problems that may be found after seeing the results.

4.Biopsy. A tissue sample is taken from the lining of the colon and checked in a lab. This test looks at the organs of the top part of the digestive system. It checks the food pipe, the stomach, and the first part of the small intestine. Your child swallows a fluid called barium. This is a thick, chalky fluid. It is used to coat the inside of organs so that they will show up on an X-ray. Then X-rays are taken to check the digestive organs.

5. Barium enema. This test checks the large intestine, including the colon and rectum. A thick, chalky fluid called barium is put into a tube. It is inserted into your child’s rectum as an enema. Barium coats the colon, so they can be seen on an X-ray and decide on the outcome of the tests.

6.CT scan These imaging tests look at the small bowel and can show any inflammation or complications.

7.Capsule endoscopy. This is a special capsule that your child swallows. The capsule is a camera that takes pictures of the small bowel again your doctor can make a better and more clear decision on your problem.

How is Crohn’s disease treated in a child?

Crohn’s disease in children is a long-term disease. There is no cure, but there are some things that can help to control the disease

  • Correct nutritional problems
  • Control the swelling and inflammation
  • Ease symptoms such as stomach, pain, diarrhea, and rectal bleeding
  • Keep complications from occurring. These include tunnels of inflammation to other organs (fistulas) and narrowing of the intestine (stricture) that causes blockages.

Your child’s doctor will create a care plan based on:

  • Your child’s age, overall health, and medical history
  • How serious your child’s case is after many tests have been carried out.
  • How well your child handles certain medicines, treatments, or therapies
  • If your child’s condition is expected to get worse over time.

  Treatment for Crohn’s disease may includng Medicine

Medicines often reduce inflammation in the colon. This may help ease stomach pain and diarrhea. More serious cases may require steroids, antibiotics, or medicines that affect the body’s immune system.

Diet for Crohns disease

Making some changes in your child’s diet may help to ease symptoms. In some cases, symptoms are made worse by milk, hot spices, or fiber. Talk with your child’s doctor In some cases, your child may use a special meal plan called an elemental diet.

Vitamins for Crohns disease

Vitamins may help prevent some problems or help maintain a remission. Because many children with Crohn’s don’t absorb nutrients normally, vitamin deficiencies are common. Your child may need lab tests to assess the nutrient levels. Talk with your child’s provider about any vitamin supplements. These treatments have risks and may cause harmful side effects.

Surgery

Surgery may help Crohn’s disease, but it can’t cure it. Surgery may help to reduce long-term symptoms that don’t get better with medicine. Surgery may also fix some problems. These include a blocked intestine, a hole or perforation, a sore or abscess, or bleeding. Types of surgery may include:

1. Draining abscesses in or near fistulas. An abscess is a collection of pus or infection. Treatment includes antibiotics, but surgery may be needed.

2. Bowel or intestinal resection. The diseased section of the intestine is removed. The 2 healthy pieces of intestine are attached. This surgery shortens your child’s intestines.

3. Ostomy. When part of the intestines is removed, a new way of removing stool from the body is created. The surgery to create the new opening is called an ostomy

What are the complications of Crohn’s disease in a child?

Children with Crohn’s disease may lose weight because they don’t get enough calories. This can happen because a child may try to avoid eating, to prevent the pain that is linked to digestion

  1. May not want to eat if he or she can’t have any favorite foods.
  2. May not absorb nutrients well through the inflamed digestive tract.
  3. Has greater nutritional needs than normal because of the disease.

Nutritional supplements or special high-calorie liquid formulas may be suggested. This is often recommended if a child has delayed growth.

Crohn’s disease may also cause other health problems such as:

  • A blocked intestine
  • A type of tunnel, called a fistula, in nearby tissues. This can get infected.
  • Problems with liver function
  • A lack of some nutrients, such as calories, proteins, and vitamins
  • Too few red blood cells or too little hemoglobin in the blood (anemia)
  • Bone weakness, either because bones are brittle (osteoporosis) or because bones are soft (osteomalacia)
  • A nervous system disorder where legs feel painful called restless leg syndrome
  • Arthritis
  • Skin problems
  • Eye or mouth redness or swelling (inflammation)  
  • After bowel resection surgery, a condition called short bowel syndrome can occur. It often happens after a large part of the small intestine is removed. The body then may not be able to digest and absorb some vitamins, foods, and nutrients, including water. This poor absorption of food and nutrients is called malabsorption. It causes diarrhea. It can also lead to poor growth and development. 

How can I help my child live with Crohn’s disease?

Crohn’s disease in children is a long-term condition. It may come and go at different times during your child’s life. Children may have physical, emotional, social, and family problems as a result of the disease. It’s important to work closely with your child’s doctor to manage and treat the condition.

  • Be sure to have the doctor check your child’s health regularly.
  •  This includes checking your child’s: Growth
  • Nutrition levels
  • Bone mineral density
  • Risk for infections
  • Immunization status
  • Any liver, eye, or skin problems

Diet changes 

No special diet has been shown to treat Crohn’s disease. Many children with the disorder can eat a fairly normal diet when their disease is stable. Talk with your child’s healthcare provider. When your child is having symptoms, it may be helpful to follow these suggestions:

1. Eat smaller, frequent meals

2.Limit foods with milk or milk products containing lactose, if there is a history of lactose intolerance.

3. Avoid greasy foods.

4. Avoid certain high-fiber foods such as popcorn, nuts, and seeds.

5. Avoid any foods that seem to have triggered your symptoms in the past.

6.Drink liquids at room temperature

7.Drink liquids between meals, not with meals

8.stay away from caffeine and fizzy drinks

9.stay away from foods with sorbitol, xylitol, and mannitol

10. Avoid sweets such as candy, cakes, and 

Avoid foods that produce more gas, such as

  • Beans
  • Peas
  • Broccoli
  • Onions
  • Cauliflower
  • Cabbage

Add foods that have more soluble fiber. This is a fiber that absorbs water. Foods that are good sources of soluble fiber include:

  • Bananas
  • Rice
  • Applesauce
  • oatmeal

Children who have short bowel syndrome after surgery for Crohn’s often have problems with diarrhea and malabsorption. Talk with your child’s doctor about how to treat this.

Children with short bowel syndrome often need help getting all the nutrition they need with Supplemental liquid feedings are sometimes used, talk to your doctor about using this system for getting the right supplements.

When should I call my child’s healthcare provider?

Call your child’s doctor if your child has symptoms of Crohn’s disease, including:

  • Belly pain
  • Loose stool
  • Rectal bleeding
  • Weight loss
  • Fever
  • Vomiting that continues
  • Sores (lesions) or leakage at the anus
  • Call your child’s provider right away if your child has Crohn’s disease and regular symptoms change or new symptoms appear.eal

Key points about Crohn’s disease in children

  • Crohn’s disease is when there is redness, swelling (inflammation), and sores along the digestive tract.
  • It is a type of inflammatory bowel disease (IBD).
  • In most cases, it affects the small intestine. But it may also affect the whole digestive tract.
  • It is a long-term (chronic) condition. It may come and go at different times in your child’s life.
  • There is no cure. Making some diet changes may help ease symptoms.
  • Medicine may help. Surgery may be needed. Medicines are usually needed for the long term.

Next steps

Tips to help you get the most from a visit to your child’s doctor .Know the reason for the visit and what you want to happen. Before your visit, write down the questions you want to be answered.At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you for your child. Know why a new medicine or treatment is prescribed and how it will help your child. Also, know what the side effects are. Ask if your child’s condition can be treated in other ways. Know why a test or procedure is recommended and what the results could mean.Know what to expect if your child does not take the medicine or have the test or procedure. If your child has a follow-up appointment, write down the date, time, and purpose for that visit. Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice regarding any changes in your child.

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About Crohn's Disease

Still Tired liveing with crohns

When my Crohn’s disease is active, my fatigue can be debilitating. Sometimes I’m forced to stop answering phone calls because I literally don’t have the energy to construct sentences. I don’t allow myself to drive because it doesn’t feel safe. I’m basically unable to do anything except the bare minimum, and when I come out on the other side I feel like I’ve been in the deepest fog.

How can I be so tired?

After experiencing fatigue like this on and off for quite a while, I began to wonder how I could possibly be SO tired. I was ‘sleeping’ ten to twelve hours a night and taking a nap during the day. What more could my body possibly want? I wasn’t working. I wasn’t moving much. In fact, I wasn’t using any more strength than necessary, and yet, it still felt like too much.

Anyone with IBD knows that when you’re sick, it often feels like more than just stool emptying from your bowels. It feels like life is emptying out too.

Fatigue and mental health

I found the fatigue contributed to my anxiety and depression, affecting my mental health too. It seemed like I was trapped in this awful cycle and all I could do is come up for air between episodes.

During that time, I took prescription sleep medication, I worked with a sleep doctor, and underwent multiple normal sleep studies. I even followed suggestions on reducing screen time, creating sleep hygiene and more, but no matter what, I felt exhausted all of the time.

Sleep versus rest

This was when I learned the difference between being asleep, and getting rest. Being in bed, tossing and turning, waking up during the night – they all impact our ability to achieve deep sleep cycles characterized by faster breathing, a faster pulse, and rapid eye movements, or REM. There were times that my body may have been unconscious, but it most certainly wasn’t at rest.

It became clear to me that I had to learn how to dedicate time to conscious rest when I was awake. To be honest, this felt awkward and like something I was embarrassed about. Have you ever sat down to do something like this?

Changes I made

There were three changes I made that over time have significantly impacted my levels of fatigue, and I’d really like to offer them as suggestions to anyone who is struggling.

  1. Scrolling through social media, even while laying in bed, doesn’t count as resting. When you brain is actively thinking about things you want, need, or are missing out on, it impacts your body’s ability to rest. Schedule in some breaks to put your phone down.
  2. Guided imagery and meditation are real things that relax your mind AND your body. I rely on the Calm app, but there are others out there as well which offer you these services right from your phone. Quieting your brain quiets your body in a real, lasting way.
  3. Aromatherapy – certain scents are tied to physical relaxation. Whether you purchase a linen spray, light a candle, burn incense or diffuse essential oils, or take a bath with bubbles or salts or bombs, aromatherapy draws upon the healing powers of the leaves, flowers, stems, bark, roots or petals of plants to stimulate the natural healing action of both your body and your mind.
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About Crohn's Disease

Tips on Asking for Support During Crohn’s or UC Flares

If you’re living with inflammatory bowel disease, you know that your life, health, abilities, and capabilities can change dramatically in a short period of time. From my experience, no matter how much I plan for the next flare, there are always things I wish I had done, I need but don’t have, or I would really benefit from help.

Asking for help during a Crohn’s or UC flare

I’ve thought a lot about this and about how it feels hard to ask for help. I don’t usually know what to ask for directly so I often keep quiet, and I never know who exactly I should reach out to in the event that I need (or want!) physical things or tangible assistance.

I wanted to share with you some thoughts I’ve put together after a lot of trial and error. To be honest, it’s SO MUCH better for my mental health and my stress levels as my symptoms increase to know that I know how to best ask for support and that I’m not alone in my trials, especially when this disease can feel so isolating.

Things that are helpful when dealing with a flare

In no particular order, here are some things that have worked for me:

  1. Keep a list in your phone of a few people who are local that you trust, and that might be able to do you a favor when you don’t feel well. Depending on your needs, this might mean stopping at the store, dropping off a cooked meal, picking up a prescription, taking you to a doctors appointment, sitting with you in the ER or visiting you at home or in the hospital.
  2. Then, add to the bottom of that list, a few people who might not necessarily be nearby, but who understand your heart. People you can call or facetime or text when you want to cry or vent or be distracted. One important note here: don’t leave out your other friends with IBD! I’ve often avoided telling them that I was doing poorly because I knew they had struggles of their own, and in retrospect, they wished they’d been able to be there for me. They understood my plight directly and agreed they’d tell me if whatever I was telling them or asking them in terms of support felt like too much at any given time.
  3. Think about your necessities during a flare: what foods or meal replacements you can tolerate, what clothes and basic household items that you both need and that would make you more comfortable, and anything that might cheer you up.
  4. If you have a roommate, live with family, have a spouse, children or pets, think about if they can help and/or have needs of their own while you are down and out.
  5. In the event that a friend or family member reaches out and asks what they can do for you, or what they can bring you or send to you, I’ve found politely declining over and over is a loss for both myself and the other person. They genuinely want to help, and I honestly could use it. I have found it to be easiest to have direct and tangible items I can ask for – such as groceries, prepared meals (or meal delivery), conversation to take my mind off of things or company when I don’t have the energy to talk.

Living with inflammatory bowel disease is hard enough, there’s absolutely no reason to decline help or support simply because you don’t know how to ask, or don’t want to inconvenience someone who has already offered.

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About Crohn's Disease

Inflammatory Bowel Disease

What is Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease is a group of chronic lifelong conditions affecting the digestive tract. It includes both Ulcerative Colitis (UC) and Crohn’s Disease (CD) which are similar but affect different parts of the intestine. UC affects the inner lining of the large intestine while CD can affect any part of the digestive tract from the mouth to the anus. You can read further information on IBD in this patient information leaflet

Clinical features of Inflammatory Bowel Disease
The main features of IBD are bloody diarrhoea associated with frequency, urgency and abdominal cramps.  In severe attacks patients may suffer weight loss and anorexia.

In addition patients may have symptoms from outside the digestive tract including:

•         Arthritis (large joints)
•         ankylosing spondylitis
•         erythema nodosum
•         pyoderma gangrenosum
•         iritis and episcleritis (inflammation of the eyeball)
•         primary sclerosing cholangitis (75% pts have IBD, Geonzon –Gonzales 2006)

How common is IBD?

•         15,000 people in Ireland have IBD
•         Incidence in Ireland – 6,000 UC
                                        – 3,000 CD

What causes IBD?
The cause of IBD is unknown but is thought to include:   Genetic susceptibility
A familial tendency 
Environmental factors -smokingstress

non-steroidal anti-inflammatory drugs  

history of appendectomy

history of infection with mycobacteria  

activation of the immune system

possibly diet but not proven

•         Infective agents
•         Seasonal changes
•         Stress – implicated in aetiology of disease  (Mawdsley & Rampton 2005)

Treatment of IBD
Treatment for IBD is often simple and includes both local and oral medications, often the condition can be managed in the community by the patient’s General Practitioner after consultation with a Specialist. Regular review by a specialist is recommended for complex therapies and disease. Surgery may be required in difficult cases.

Mary Kennedy is the IBD Clinical Nurse Specialist at TUH. The IBD nurse is often your first point of contact if you require any advice regarding your disease. She provides a rapid point of access for IBD patients, in particular she can provide support, advice and information on your inflammatory bowel condition. Also, she will play an active role in disease and drug education and management. Treatments such as Infliximab (Remicade) and Adalimumab (Humira) are administered by the IBD Nurse.

An advice line is run by the IBD Nurse and the contact number is 01 414 3855.

TUH Gut Therapy Programme for IBS
The chronic diarrhoea pathway aims to provide patients with diarrhoea symptoms of Irritable Bowel Syndrome (IBS) with fast access to the most appropriate investigations and management of their condition. Patients aged over 45 with chronic diarrhoea of more than one month duration will be automatically be triaged for a colonoscopy. If this and blood tests are normal they subsequently attend the dietitian led gut therapy clinic.

Patients aged under 45 with chronic diarrhoea of more than one month duration with red flag symptoms such as bleeding, weight loss, anaemia and family history of bowel cancer or IBD will also be automatically be triaged for a colonoscopy. If this and blood tests are normal they subsequently attend the dietitian led gut therapy clinic. 

Patients under 45 who do not have red flag features will have blood and stool tests done. If these are normal they attend the dietitian led gut therapy clinic, if an abnormality is detected they have a colonoscopy and are managed as appropriate after that.

Its most notable attribute is its effect on wound management and healing. Manuka honey also has antibacterial, antiviral and anti-inflammatory properties that may help treat numerous ailments, including irritable bowel syndrome, gastric ulcers, periodontal disease and upper respiratory infections.

Honey is well known for its anti-inflammatory and antioxidant capacities, which may be useful for the prevention of chronic inflammatory process like atherosclerosis, diabetes mellitus and cardiovascular diseases. The antibacterial, anti- inflammatory and antioxidant properties of honey

What is the fastest way to get rid of inflammation in the body?Follow these six tips for reducing inflammation in your body:

  1. Load up on anti-inflammatory foods. …
  2. Cut back or eliminate inflammatory foods. …
  3. Control blood sugar. …
  4. Make time to exercise. …
  5. Lose weight. …
  6. Manage stress.

Does b12 reduce inflammation?Vitamin B6, folate (B9), and B12 can lower your levels of homocysteine, an amino acid that’s linked to a greater risk for heart disease and rheumatoid arthritis. But we can’t say for sure that lowering homocysteine will also lower your risk for disease. The same is true for C-reactive protein, a sign of inflammation.

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