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Dietary Management in Pediatric Crohn's Disease - An Overview

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Crohn's disease is a disease involving the digestive tract. Read the article about Crohn's disease in pediatric patients and its dietary management.

Written by

Dr. Sophia. S

Medically reviewed by

Dr. Bhaisara Baraturam Bhagrati

Published At February 9, 2023
Reviewed AtJuly 17, 2023

Introduction:

An inflammatory bowel disease is a group of intestinal conditions that result in persistent inflammation of the digestive system. The digestive tract involves the mouth, esophagus, stomach, small intestine, and large intestine, responsible for breaking down food, extracting nutrients, and removing waste products. This process is disrupted by inflammation and can be extremely painful. Rarely, it might be fatal.

What Are the Common Types of Inflammatory Bowel Disease?

The common types of inflammatory bowel disease are

  • Ulcerative Colitis: It affects only the digestive tract and involves inflammation of the large intestine. However, it may involve other non-digestive issues.

  • Crohn's Disease: It causes inflammation of any part of the digestive tract. However, it primarily affects the tail end of the small intestine.

What Are the Causes of Crohn's Disease in Children?

Crohn's disease is a lifelong, incurable condition whose exact cause is unknown. However, several factors can increase the risk of developing Crohn's disease.

1. Family History and Genetics:

  • The risk of Crohn's disease is significantly increased if they have a parent, sibling, or child with the condition.

2. Immune Response:

  • A viral or bacterial infection of the digestive tract can trigger an immune response, causing inflammation of the digestive tract. When an immune system functions correctly, the inflammation subsides once the infection is treated.

  • But in Crohn's disease, inflammation can occur even when there's no infection, and the immune system attacks the body's cells leading to an autoimmune response.

3. Environmental Factors:

  • People who live in industrialized areas have a higher risk of developing Crohn's disease because they tend to eat more fat and processed food.

What Are the Symptoms of Crohn's Disease?

The symptoms of Crohn's disease often occur slowly. However, certain symptoms may also worsen over time. Depending on where and how severe the inflammation is, the symptoms of Crohn's disease can include the following:

  • Fever, fatigue, and loss of appetite.

  • Diarrhea occurs when affected parts of the bowel cannot reabsorb water.

  • Bleeding ulcers may lead to bloody stool.

  • Stomach pain, cramps, and bloating due to bowel obstruction.

  • Malnutrition and weight loss can cause delayed physical growth or development in children.

As the disease progresses, the symptoms may become more severe. Some of the more severe symptoms include:

  • Ulcers that occur from the mouth to the anus in any place.

  • Increased inflammation of the skin and joints.

  • Decreased ability to do exercise due to anemia and causing shortness of breath.

What Are the Available Treatment Modalities for Crohn's Disease?

Children with Crohn's disease need to receive proper care because untreated Crohn's can stunt growth and weaken bones. It might also result in significant emotional distress at this point in life.

The available treatments include

  • Antibiotics: Antibiotics can treat or prevent infections that cause fistulas or abscesses.

  • Biologics: These drugs suppress the immune system by using monoclonal antibodies.

  • Bowel Rest: Your doctor might advise fasting for a few days or longer so that your intestine can heal, where nutrition can be obtained intravenously, through a feeding tube, or by drinking a liquid diet that has been prescribed.

  • Antidiarrheal Medication: Prescription medications like Loperamide can stop severe diarrhea.

  • Corticosteroids: Cortisone, Prednisone, and other corticosteroids reduce the inflammation caused by the autoimmune disease.

  • Immunomodulators: Drugs like Azathioprine and Cyclosporine can suppress the overactive immune system and reduce inflammation.

  • Surgery: Although surgery can not cure Crohn's disease, it can treat complications like intestinal perforations (holes), blockages, or bleeding.

What Are the Dietary Management for Pediatric Crohn's Disease?

  • Though food does not cause Crohn's disease, it can trigger flares. A diet plan that works for one child may not work for another because the disease can involve different areas of the gut in different children.

So it is essential to identify dietary plans and create guidelines for a balanced diet that suits the child.

  • Adjust the Fiber Intake: Some children need a high-fiber, high-protein diet, while for others, extra food residue from high-fiber foods such as fruits and vegetables may aggravate the GI tract. Hence, choose a diet based on personal needs.

  • Limit the Fat Intake: Crohn's disease will make it more difficult for your body to digest and absorb fat. It can result in diarrhea when this extra fat travels from your small intestine to the colon.

  • Limit the Dairy Intake: In Crohn's disease, the child can develop difficulty digesting some dairy products, causing stomach upset, abdominal cramps, and diarrhea.

  • Drink Enough Water: Crohn's disease may lead to dehydration in some children by affecting the body's ability to absorb water from the digestive tract.

  • Add Alternative Sources of Vitamins and Minerals: Since vitamins and minerals are not adequately absorbed from food, add multivitamins to the diet by consulting your doctor to find out if this is right for you.

What Are the Other Natural Treatments Available for Crohn's Disease?

  • Some people manage their symptoms using natural treatments complementary to prescription medications. However, since the Food and Drug Administration (FDA) has not approved these for treatment, please consult your doctor before taking them.

Some natural approaches to Crohn's disease symptoms include,

  • Probiotics: Probiotics help to prevent harmful microorganisms from upsetting the gut's natural balance and causing a Crohn's flare.

  • Prebiotics: These are found in plants, such as asparagus, bananas, artichokes, and leeks, that promote good bacteria in the gut.

  • Fish Oil: Oily fishes like salmon and mackerel are rich in omega-3 fatty acids, which can be used to treat Crohn's disease.

  • Supplements: Certain herbs, vitamins, and minerals ease the inflammation associated with Crohn's disease.

  • Aloe Vera: Some people use aloe vera to reduce gut inflammation because of its natural anti-inflammatory property.

  • Acupuncture Treatment: A study found that treatment combined with moxibustion (a type of Chinese medicine that requires the burning of dried medicinal herbs near the skin) can improve the symptoms of Crohn's disease.

When to Consult the Doctor?

Consult a doctor if persistent changes are experienced in bowel habits or any of the symptoms listed below:

  • Extreme weight loss.

  • Blood in stool.

  • Severe abdominal pain.

  • Fever.

  • Nausea and vomiting.

  • Inability to pass gas.

  • Constipation.

  • Uncontrollable diarrhea.

What Are the Complications of Crohn’s Disease?

Possible complications of Crohn's disease include,

  • Malnutrition results in weight loss.

  • Colorectal cancer.

  • Fistulas through the bowel wall, creating a hole between different parts of the digestive tract.

  • Intestinal rupture or perforation can lead to leakage, infections, and abscesses.

  • Stricture causes a part of the gut to narrow, causing a buildup of scar tissue and a partial or complete blockage of the intestine causing Bowel obstruction.

  • Rarely, Crohn's disease may result in shock, causing blood loss during a long, sudden episode of bloody diarrhea, which can be fatal.

Conclusion:

While there is no cure for Crohn's disease, medications and lifestyle adjustments can prolong remission and reduce complications. More effective therapies and cures are still being researched. Consult the doctor to find the proper medications, alternative treatments, and lifestyle measures to help the child.

Frequently Asked Questions

1.

What Are the Dietary Requirements for Crohn’s Disease?

Characterized by chronic inflammation, Crohn's disease affects the lining of the digestive tract. Adjusting the diet can help in better management of the symptoms of Crohn’s disease. To support easier digestion, it is recommended to steer clear of fiber-rich foods, dairy products, and fatty meats, while favoring baked or steamed food options

2.

How Is Crohn’s Disease in Children Managed?

Pediatric patients with mild forms of Crohn’s disease are managed with preparations of 5-aminosalicylic acid (5-ASA) and antibiotics. Nutritional therapy is also given. If there is no response or if the disease is severe, corticosteroids and immunomodulatory therapy with 6-mercaptopurine or Methotrexate are administered.

3.

What Is the Ideal Treatment for Pediatric Crohn’s Disease?

Drug therapy is the ideal treatment for pediatric Crohn’s disease. Drugs help reduce inflammation, control symptoms, and also allow the body to absorb nutrients. Anti-inflammatory drugs are mainly used in the management of pediatric Crohn’s to control the symptoms. These drug help bring the disease under control.

4.

What Is the Ideal Diet for Crohn’s Disease?

The best diet for Crohn’s disease is to increase the consumption of foloowing food itetms:
 - Raspberries.
 - Bananas,
 - Blended fruit.
 - Green beans.
 - Tenderly cooked carrots.
 - Walnut butter.
 - Chia seeds. 
 - Flaxseed meal.
 - Flaxseed oil.
 - Foods rich in omega-3 fatty acids such as mackerel, tuna, and sardines. 
It is best to avoid high-fiber foods and dairy products.

5.

What Are the Essential Vitamins for Children With Crohn’s?

Due to its anti-inflammatory properties and facilitation of calcium and phosphorus absorption from food, vitamin D is advised for all patients with Crohn's disease to help manage inflammation. It also relieves fatigue and increases bone density in pediatric patients with Crohn’s disease. A zinc supplement may also be recommended because the levels of zinc in the body are reduced due to prolonged diarrhea.

6.

What Are the Vegetables That Can Be Consumed in Crohn’s Disease?

Individuals with Crohn’s disease should avoid certain vegetables that can cause flare-ups. It is good to consume vegetables, like green beans, eggplants, cucumbers, carrots, potatoes, zucchini, and lettuce. If there is no sensitivity to any other vegetables other than this, those vegetables can also be consumed.

7.

What Fruits Should Not Be Consumed in Crohn’s Disease?

Individuals with Crohn’s disease should avoid fruits that exacerbate diarrhea and bloating. It includes mango, watermelon, pears, apples, figs, and avocado. Fruit juices with pulp should be avoided. Dried fruits, such as raisins and prune juice should be avoided as they can trigger flare-ups.

8.

What Fiber Supplement Is Best for Crohn’s?

Though individuals with Crohn’s disease should avoid high-fiber foods, fiber is essential for maintaining gut health. Soluble fibers help in bulking up the stool, while insoluble fibers cannot be digested and tend to cause loose stools. Soluble fiber supplements are the best for individuals with Crohn’s disease.

9.

What Is the First Line Treatment for Crohn’s Disease?

Anti-inflammatory drugs are the first line of treatment in the management of inflammatory bowel disease. This includes corticosteroids such as Prednisolone and Budesonide. They help reduce inflammation but they do not work in all individuals with Crohn’s disease. The primary objective of treatment is to diminish inflammation and prevent the reoccurrence of flare-ups

10.

What Remedy Helps in Crohn’s Disease?

Natural remedies along with medicines also help in controlling Crohn’s disease. Natural remedies like consuming foods rich in prebiotics, probiotics, fish oils, curcumin, aloe vera, bromelain, thunder god vine, apple cider vinegar, and essential oils. Other remedies like avoiding triggers, consuming a low-fiber diet, and acupuncture also help.

11.

What Probiotic Is Best for Children With Crohn’s?

Studies have shown that the probiotic Saccharomyces boulardii causes various benefits in Crohn’s disease by preventing and maintaining remission. This helps reduce inflammation, controls the symptoms like prolonged diarrhea, and improves gut health. The best probiotic to choose for the child largely depends on their requirements.

12.

Can Pediatric Crohn’s Be Cured?

Affecting the entirety of the digestive tract, Crohn's disease is a chronic condition. This disease may come and go at different stages in the child’s life, but it cannot be cured. However, following a proper diet, and medications can help prevent flare-ups and in maintaining gut health.

13.

What Are the Foods That Are Best and Worst for Crohn’s?

Foods that are best for Crohn’s disease include raspberries, bananas, applesauce, blended fruit, green beans, carrots, fatty fish, walnut butter, chia seeds, flaxseed oil, and flaxseed meal. It is recommended to refrain from consuming dairy products, high-fiber foods, alcohol, broccoli, and cauliflower.

14.

What Are the Risk Factors Associated With Crohn’s?

There is no known reason for the development of Crohn’s but certain factors can increase the risk of Crohn’s disease. This includes a family history of the disease; a high-fat diet; medications such as antibiotics, birth control pills, nonsteroidal anti-inflammatory drugs, and smoking.
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Dr. Bhaisara Baraturam Bhagrati
Dr. Bhaisara Baraturam Bhagrati

Pediatrics

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