Pediatric Inflammatory Bowel Disease: Challenges And Management

Early management of IBD (early diagnosis and prompt initiation of treatment) is critical to improving quality of life and preventing complications.

World IBD Day 2023: Inflammatory bowel disease (IBD) is a chronic condition that causes swelling or inflammation in the intestine, not due to infection. Therefore, Dr Suresh Kumar Panuganti, Lead Consultant-Pediatric Critical Care and Pediatrics, Yashoda Hospitals Hyderabad, explains that early management of IBD (early diagnosis and prompt initiation of treatment) is critical to improving quality of life and preventing complications.

IBD Includes Two Major Diseases:

• Ulcerative colitis (it affects the lining of the large intestine) and Crohn's disease (it can affect both the small and large intestine).
• Onset is usually in early childhood or adolescence and tends to be a lifelong disease, but with effective treatment, a child can be free of symptoms for prolonged periods.
• A subgroup of IBD called very early-onset IBD (VEO-IBD) affects kids younger than 6; it is usually aggressive, more frequently has a genetic foundation, and may need different treatments.
• IBD has long-term effects on a child - both physical and psycho-social; it negatively affects growth, development, psycho-social function, and overall well-being.
• Genes, environmental factors, and the immune system cause IBD.

Exclusive Enteral Nutrition: EEN

There are unique, balanced formulas (exclusive enteral nutrition, EEN) that provide adequate nutritional requirements for a child. This enables the bowel to heal and return to its healthy normal state and also helps children regain the weight they have lost because of their condition. It is usually given to a child once they are first diagnosed with Crohn's disease and during relapses. Other special diets available for pediatric IBD include a specific carbohydrate diet (SCD), an IBD-anti-inflammatory diet (IBD-AID), and Crohn's disease elimination diet (CDED). In developing countries, the availability of these unique formulas and their cost is a major limiting factor.

Another Challenge In Pediatric IBD Is Vaccination

Vaccination protects from various infectious diseases in young children, but a child with IBD receiving immunosuppressive therapy should not receive live vaccines. Instead, they should be under regular follow-ups with the paediatrician to protect them from infectious diseases.

Treatment

The disease's location and severity determine the course of treatment and whether your child has Ulcerative colitis or Crohn's disease. Unfortunately, there is presently no permanent cure. However, treatment can help control the illness. Treatment aims to reduce inflammation, treat symptoms, address dietary issues, and promote healthy growth and puberty.

• Medications control or stop inflammation, reduce inflammation, control pain, and optimise growth (vitamins and minerals).
• One of the main challenges of IBD in children is timely diagnosis and compliance to (continuation of) treatment. In addition, nutrition plays a significant role.
• A typical, balanced diet is ideal for someone with IBD. This means a child can eat anything from any food group.
• No particular food has been shown to cause Crohn's disease or ulcerative colitis, although some people may find that certain foods can make their symptoms worse.