It’s estimated that more than half a million people in the United States have Crohn’s disease (CD). While it’s most likely to develop in individuals who are 20 to 29 years old, 1 in 4 are estimated to show symptoms before they reach 20 years old.

Those who experience CD early in life can experience growth delays. If you’re a younger individual with CD or if you’re the parent of a child with CD, you may be wondering why this occurs and what can be done to help.

While it’s important to discuss any medical questions and concerns about your child’s development with their healthcare professional, we’ve gathered some information that may help you feel more prepared to have that conversation.

To understand how CD impacts children, it’s necessary to understand what exactly CD is.

CD is a type of inflammatory bowel disease that doesn’t currently have a cure. It most commonly occurs in the small intestines and the colon but can occur anywhere from the mouth to the anus. (It can also be present in part of the digestive tract and then skip a section.)

Early symptoms of CD in children and teens can include:

It’s possible to initially confuse these symptoms with food poisoning, allergies, or just an upset stomach. It’s important to see a doctor or healthcare professional if they persist because early diagnosis can help an individual avoid more severe complications.

As CD progresses over time, the symptoms may become more severe. It may cause:

Symptoms of CD can range from mild to debilitating. They can also change over time and involve life-threatening flares. More research is needed on how CD begins and the best ways to manage it.

Delays in growth and delayed puberty are common in those with a pediatric CD diagnosis. Up to two-thirds of children with a CD diagnosis have impaired weight at the time of their diagnosis and up to one-third have impaired height. Growth delays in children can begin even before CD is diagnosed.

These growth delays may be caused by:

  • reduced nutrient intake
  • poor absorption of nutrients
  • increased bowel movements
  • effects from inflammation and treatments

Males are more likely than females to experience growth delays because the male growth spurt during puberty is greater, starts later, and lasts longer.

Those individuals with substantial inflammation are at a higher risk of growth delays. If growth delays due to CD aren’t corrected, they can impact an individual’s final adult height. There are also concerns about low bone density for those with pediatric CD. Concerns about bone density can continue even when the child’s weight and height are tracking as expected, so this requires its own monitoring.

In addition to concerns with height and weight, those individuals with CD approaching puberty may experience a delay in the onset. Those assigned female at birth can also experience a delay or absence of menstruation. This is believed to be due to:

  • malnutrition/reduced fat mass
  • disruptions to the endocrine system due to inflammation

Delayed growth is usually a secondary result of CD’s actions. So, any treatments suggested by doctors to help put CD in remission and prevent flare-ups will generally have a positive effect on the individual’s growth, too.

One commonly recommended treatment option for children with CD is exclusive enteral nutrition. This means relying on a formula-based diet (without solid foods) for a short period of time. Exclusive enteral nutrition can cause CD to go into remission and help ensure that children get the nutrition they need to meet growth goals.

Because of the risks of decreasing bone mass, long-term corticosteroid therapy to treat inflammation is generally avoided, particularly for younger individuals with CD. This is another reason why some doctors use methods such as exclusive enteral nutrition, which can help lower inflammation in other ways.

Some other treatment options include:

  • antibiotics
  • aminosalicylates
  • biologics
  • immunomodulators
  • surgery to address specific symptoms

Long-term control of inflammation and sufficient nutrient intake are key to promoting typical puberty in those with pediatric CD. Using immunosuppressants or biologics early to achieve remission and allow growth to catch up before puberty may be beneficial.

Studies on animals have suggested that cytokines and other mediators of inflammation have a suppressant effect on sex hormones. This can be reversed using anti-TNFα antibodies, and more research to fully understand the effects of these antibodies on children with CD and other inflammatory diseases is ongoing.

Proper diagnosis and treatment of CD in children is critical to preventing growth delays or weakened bones.

In addition to physical effects, CD can cause significant emotional stress, so it’s important to make sure children with CD are getting any holistic care they may need.

More research into the effects of CD on children and how to best treat it is still needed. You’ll want to consult with a doctor as soon as possible if you or someone you know is showing symptoms of CD so that treatments can be started as soon as possible.