What is Crohn’s disease? Crohn’s disease is an autoimmune disease that can accumulate throughout the digestive tract (including the mouth, stomach, intestines, and anus) and can cause diarrhea, abdominal pain, and other symptoms. The pathogenesis is currently unclear. In simple terms, it is called “autoimmunity” in which the immune system, which is supposed to help people fight against the invasion of pathogenic microorganisms, suddenly turns around and attacks the normal organs and tissues of the digestive tract. As autoimmunity attacks the digestive tract, it causes many ulcers in the digestive tract, bleeding and diarrhea. What are the symptoms of Crohn’s disease in children? The most common ones are: abdominal pain, diarrhea, blood in the stool or mucus and blood, and gradual loss of weight; more specifically than in adults, they include: slow or stagnant height growth, resulting in a significantly shorter child; delayed puberty; and cessation of menstruation in girls. In addition, Crohn’s disease may also have some specific manifestations such as rash, perianal abscess, mouth ulcers, joint pain, and congested eyes. These symptoms can recur, and if not treated properly, they can get worse and worse, even leading to serious complications such as perforation and intestinal obstruction. What tests do children with Crohn’s disease need to have? Children with Crohn’s disease require a number of tests to clarify the diagnosis and rule out other diseases that may cause similar manifestations, and to assess the activity of the disease, rule out certain contraindications to treatment, and prepare for the development of a treatment plan. The usual tests are: 1) various hematological tests: to assess the activity of the disease, nutritional status and infection; 2) pathogenic microbiological tests: to exclude infectious diseases that can cause similar symptoms, such as intestinal tuberculosis, amebic dysentery, bacillary dysentery, etc.; 3) endoscopy: since Crohn’s disease can accumulate throughout the gastrointestinal tract, most children need both gastroscopy and colonoscopy. The doctor can directly find the lesion site through endoscopy, assess the extent of the lesion, and take a tissue biopsy to further confirm the diagnosis through microscopic observation; 4, imaging examination: because the above-mentioned endoscopic examination does not know the extent of the lesion in the small intestine, and because of the limited abdominal space in children, the application of small intestinal microscopy is more restricted and difficult to operate, so hospitals with conditions will let children undergo small intestine CT or This will give further information about the lesions in the small intestine and help the doctor to develop a reasonable treatment plan. 5, genetic testing: Adult Crohn’s disease is a disease caused by a variety of environmental factors in a genetic background. However, for Crohn’s disease in children under 5 years of age, especially if the disease develops shortly after birth, it may be part of the manifestation of an immunodeficiency disease or other genetic metabolic disease and should be tested for certain genes. More than 50 single gene mutations are known to cause Crohn’s-like manifestations. In general, the vast majority of infants and children with Crohn’s disease due to single gene mutations do not respond well to conventional treatments (including hormones, biologics), and some even require stem cell transplantation. Therefore, if a child has a very early onset of the disease or has a family history, genetic testing can help determine the direction of treatment. How is Crohn’s disease treated in children? 1. Medications can be used to help keep the disease under control. Some medications can lead to rapid remission (glucocorticoids, biologics – anti-tumor necrosis factor monoclonal antibodies) and some medications can stabilize the disease after remission and reduce relapses. Therefore, the child may need to take multiple drugs at the same time to keep the disease under control. 2. In addition to medication, strict dietary restrictions should be made. The daily diet should limit the intake of sugars, no cereals, lactose and sucrose, limit the intake of legumes and tubers, limit the intake of coarse grains, avoid tobacco (second-hand smoke), alcohol, fried, spicy, coffee, strong tea and other stimulating foods, avoid processed foods containing margarine, butter, and many additives. When the disease is still active, it is sometimes necessary to avoid daily foods altogether and to feed through specially formulated enteral nutrition preparations. Current research has found that the use of specialized enteral nutrition preparations not only significantly improves the nutritional status of the child and restores weight, but also heals the mucosa of the digestive tract, reduces the activity of the disease, and provides a therapeutic effect. Especially in children with mild to moderate Crohn’s disease, sometimes this complete enteral nutrition is enough to control the disease. In addition, due to dietary restrictions, it is difficult for children to get enough nutrients from regular food, and even if enteral nutrition is used, most of the time, various micronutrients and vitamins need to be supplemented. 3. When the disease cannot be controlled by diet and medication, or when the disease causes serious complications, doctors will consider surgical treatment to remove part of the diseased tissue or release the obstruction site. With regular treatment and dietary intervention, most children with Crohn’s disease will go into remission and live as normal. However, due to the disease, many affected children may be shorter in height than children of the same age and have a delayed age of pubertal development. If height is already significantly shorter, they can be evaluated by a pediatric endocrinologist, and some children can achieve normal height with growth hormone injections. In addition, Crohn’s disease increases the risk of developing colon cancer in the future. Therefore, regular colonoscopy (1 time/year) is needed after adulthood for early detection of bowel lesions that appear cancerous.