Treatments

Pediatric IBD is a chronic inflammatory condition. A chronic condition does not mean that the disease is life threatening. It does mean that even with treatment to control your child’s symptoms, the disease will not go away. Because your child will have to manage the disease with various treatments throughout his or her life, it is important to know about what treatments are available and how they can help keep symptoms well-controlled.

  • Understanding Goals of Treatment
  • Treatments for Crohn’s disease
  • Treatments for ulcerative colitis

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Understanding the goal of treatment
When you begin any new treatment for your child’s inflammatory bowel disease (IBD), it is helpful to discuss the following points with your child’s group of providers including the doctor to make a plan that you understand and decide on together as a team.
 
What is the goal of this treatment?
In most cases, the goal of treating your child’s IBD will be one or all of the following:
•bring down the inflammation and swelling of the intestine
•heal tissue
•relieve your child’s IBD symptoms
•help normal growth and development
•control and even prevent complications
 
It is important that you know exactly what the treatment is supposed to do for your child. Always remember to get the correct spelling of any medications and clear dosing instructions from your child’s healthcare provider.
 
And remember that treating your child’s IBD is a way to manage the disease and not cure it. Although researchers are making new discoveries every day, there is no cure for Pedi IBD at this time.
 
How long will my child be on the treatment before we can expect to see how well the treatment is working?
It is important to have realistic expectations of not only what the treatment should accomplish but an understanding of when to expect the hoped for results.
Some medications don’t kick in for a few weeks or even a few months.  Knowing this ahead of time can help to avoid the frustration that can come when you don’t see immediate results. This can also help prevent you and your child from discontinuing a treatment before it has time to work.
 
How will my child’s doctor monitor the progress of the treatment?
Your child’s doctor may use the following procedures to keep track of the progress of your child’s disease and how effective the treatment is:
•physical exam
•height/weight measurement
•lab tests
•radiologic studies
•endoscopies
Know at what intervals – monthly, weekly, etc – the procedures will happen. Scheduling and keeping these appointments is important to help make sure your child’s treatment is working as your doctor thinks it should. 
 
If, for some reason, your child is not responding to the treatment in an appropriate amount of time, your healthcare provider can make changes in your child’s treatment plan.
 
What common side effects of the treatment should we know about?
Always ask your child’s physician or nurse about what common side effects you might expect. The doctor may adjust the medication dosage or prescribe additional medications to reduce the possibility of your child experiencing these side effects. 
Be aware of any changes or symptoms your child may be experiencing. Knowing what to look for and how to treat some of the common side effects that come with new treatments can greatly reduce the stress for both you and your child.
 
What serious side effects of the treatment should we get immediate medical attention for?
It may be scary to hear about but knowing the serious side effects ahead of time is very important. The more quickly you can recognize a serious side effect and get treatment, the better.
•ask your physician to let you know exactly what signs and symptoms to be watchful for
•discuss how to reach your doctor in case of such an emergency
•ask for access to his or her paging service for issues that might come up after regular office hours
•have a plan in place for getting to the closest emergency room
 
Although most children do not have serious side effects from Pedi IBD treatments, having a plan in place can help you and your child feel more prepared in the rare case of an emergency.

 Maintenance Care

Together with the treatment described above, all children with IBD need to continue a program of health maintenance. This includes:

  • routine immunizations (with the exception that if your child is on immune suppressing medications, no live vaccines are given)
  • annual flu shot
  • ophthalmology examination every 1-2 years
  • dermatologic examination in pediatric IBD patients over 16 years old
  • bone density testing (DXA) every 2-3 years
  • transition care for adolescents (taking charge of their own treatment)
Treatment for Crohn's

The goal of treating your child’s Crohn’s disease is to help your child experience periods of remission, when your child feels no or only a few symptoms of the disease. 

Right now, even with treatment, the disease will usually come back at different times during your child’s life. 

Crohn’s disease is a chronic inflammatory condition that can affect any part of the digestive tract. A chronic condition does not mean that the disease is life threatening. It does mean that even with treatment to control your child’s symptoms, the disease will not go away. 

Your child will have to manage their disease with various treatments throughout his or her life. And though there is no cure for Crohn’s disease yet, symptoms can usually be well controlled with proper treatment. 

What are the treatments for Crohn’s disease?

Treatment of your child’s Crohn’s disease can include: 

  • medications
  • nutrition supplements
  • surgery
  • counseling and alternative approaches (e.g., stress reduction)
  • combination of these options 

The goals of treatment are to: 

  • Control inflammation
  • correct nutritional deficiencies
  • relieve and/or control symptoms 

Treatment of your child’s Crohn’s disease can depend on: 

  • the location and severity of disease 
  • other complications 
  • your child’s response to other medical treatments 

The goals of treatment will be different depending on if your child’s Crohn’s disease is active and flaring or if his or her symptoms are under control with treatment. 

Induction Therapy

If your child is experiencing symptoms that are interrupting his or her daily activities and your child’s doctor has decided that treatment is needed, your child will begin induction therapy. The goal of induction therapy is to get your child’s inflammation under control as quickly, safely and effectively as possible. 

Maintenance Therapy

Once induction therapy has helped your child’s disease into remission, or when his or her symptoms are much better, your child’s doctor will transition to maintenance therapy. The goal of maintenance therapy is to maintain or continue your child’s remission and to stop the disease symptoms from flaring again. 

Drug Therapies

ANTI-INFLAMMATION DRUGS ACTIVE INGREDIENT – MESALAMINE

Most children with Crohn’s disease are first treated with drugs containing mesalamine, a substance that helps control inflammation such as: 

  • Sulfasalazine 
  • 5 ASAs (e.g., Asacol/Delzicol, Pentasa, Lialda) 

The goal of anti-inflammation drugs is to control inflammation. Possible side effects of drugs with mesalamine in them can include: nausea, vomiting, heartburn, diarrhea, headache. 

CORTISONE OR STEROIDS

(corticosteroids)

While being used less and less as more options become available, cortisone drugs and steroids, or corticosteroids, can be used when your child’s Crohn’s disease is flaring to get symptoms under control quickly. Corticosteroids are sometimes used for induction therapy. The dosage is lowered once symptoms have been controlled. 

These drugs have serious side effects and are not to be used for the long-term management of your child’s Crohn’s disease. Prednisone is a common generic name of one of the drugs in this group of medications. Side effects of corticosteroids can include: 

  • greater susceptibility to infection 
  • increased appetite 
  • indigestion 
  • increased anxiety
  • mood swings 
  • acne 
  • osteoporosis or brittle bones 
  • hypertension 
  • dependence on corticosteroids 
  • resistance to corticosteroids 
  • weight gain 

IMMUNE SYSTEM SUPPRESSORS

These drugs help to suppress your child’s immune system. The most common immune system suppressing drugs are: 

  • 6-mercaptopurine or azathioprine
  • methotrexate 

Immunosuppressive agents work by blocking the immune reaction that causes inflammation. 

At times, your child may be prescribed a combination of corticosteroids and immunosuppressive drugs. 

Research suggests that immunosuppressive drugs may help corticosteroids to work better. If your child is treated with a combination of corticosteroids and immunosuppressive drugs, it is hoped that the dose of corticosteroids can be lowered in order to reduce the risk of your child becoming dependant on them. 

Side effects of immunosuppressive drugs can include: nausea, vomiting, diarrhea, lowered resistance to infection, pancreatitis. 

BIOLOGICS

Remicade, Humira, Cimzia, Simponi, Entyvio, Stelara, and other newer forms of biologic medications block certain parts of the body’s inflammation response. This is the newest form of treatment for Crohn’s disease. 

ANTIBIOTICS

(ampicillin, cephalosporin, tetracycline, metronidazole, ciproflaxacin)

Antibiotics are used to treat bacteria in your child’s small intestine than can be caused by stricture, fistulas, or earlier surgery. Antibiotics may also change the bacteria in the intestine that might favor less inflammation and help intestinal healing. 

ANTI-DIARRHEAL AND FLUID REPLACEMENTS

(diphenoxylate, loperamide)

Diarrhea, abdominal pain and cramping can get better when the inflammation is under control, but other medication may also be needed to keep these symptoms from coming back. If your child is dehydrated because of diarrhea, he or she can be treated with fluids and electrolytes. Antidiarrheal medications are not usually used in children due to concern about side effects. 

Nutritional Therapies

Some children may decide to try strict nutritional treatment (using a formula) instead of medications. In many children with Crohn’s disease, this treatment can be as effective as the medications. If you are interested in this option, discuss this with the doctors and nurses taking care of your child. 

If your child’s growth or development is slow, the doctor may recommend nutritional supplements. Special high-calorie drinks can be helpful in this case. A small number of children may need to be fed intravenously for a short time through a small tube inserted into the vein of the arm. This therapy can help children who need extra nutrition, those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food. 

Surgical Therapies

Many patients with Crohn’s disease have surgery at some point in their lives. Surgery may be considered by your child’s gastroenterologist if: 

  • your child’s Crohn’s disease does not respond well to medications
  • symptoms cannot be controlled by medications or nutritional therapies
  • to correct complications such as blockage, perforation, abscess, or bleeding in the intestine 

Surgery to remove part of the intestine can help children with Crohn’s disease, but it is not a cure. 

Surgical Treatments

Surgical treatments for Crohn’s disease can include 

  • partial resection (e.g., removing an affected piece of the intestine causing problems that are not responding to medical treatements) 
  • ileostomy 
  • colostomy 
  • subtotal colectomy 

which remove or shorten severely diseased or inflamed parts of the intestine and allow waste products to leave the body. 

Each child is different, and not every surgical procedure is right for every child. Because a surgical treatment can affect your child and your family’s lifestyle significantly, it is very important to discuss your questions and concerns with your child’s medical team before the surgery. In some cases, you may have access to specialists such as an ostomy nurse or enterostomal therapist who has expertise and experience in counseling and caring for children and families before and after intestinal surgeries. Talking with other patients and parents who have been through surgery for similar problems can also be very helpful and reassuring. A good resource for more general questions or concerns is the United Ostomy Association.

Treatment for Ulcerative Colitis

The goal of treating your child’s ulcerative colitis is to help your child experience periods of remission, when they feel ono or only a few symptoms of the disease.

What are the treatments for ulcerative colitis?

  • Medications
  • Nutritional therapies
  • Counseling and alternative approaches (e.g., stress reduction)
  • Surgical treatments

Right now, even with treatment, the disease will usually come back at different times during your child’s life.

Ulcerative colitis is a chronic inflammatory condition of the colon. A chronic condition does not mean that the disease is life threatening. It does mean that, even with treatment to control your child’s symptoms, the disease will not go away. The one exception with ulcerative colitis is surgical removal of the entire colon, that will cure the disease.

Your child will have to manage their disease with various treatments throughout his or her life.

Though surgery can sometimes offer a cure for ulcerative colitis, symptoms can usually be well controlled with proper treatment.

Treatment of your child’s ulcerative colitis can include:

  • medications
  • nutrition supplements
  • counseling and alternative approaches (e.g., stress reduction)
  • surgery
  • combination of these options

The goals of treatment are to:

  • control inflammation
  • correct nutritional deficiencies
  • relieve and/or control symptoms

Treatment of your child’s ulcerative colitis can depend on:

  • the location and severity of disease
  • other complications
  • your child’s response to other medical treatments

Though surgery can offer a cure for ulcerative colitis, symptoms can usually be well controlled with proper treatment.

The goals of treatment will be different depending on whether your child’s ulcerative colitis is active and flaring or if his or her symptoms are under control with treatment.

Induction Therapy

If your child is experiencing symptoms that are interrupting his or her daily activities and your child’s doctor has decided that treatment is needed, your child will begin induction therapy.

The goal of induction therapy is to get your child’s inflammation under control as quickly, safely and effectively as possible

Maintenance Therapy

Once induction therapy has helped your child’s disease into remission, or when his or her symptoms are much better, your child’s doctor will begin maintenance therapy.

The goal of maintenance therapy is to maintain or continue your child’s remission and to stop the disease symptoms from flaring again.

Drug Therapies

ANTI-INFLAMMATION DRUGS

ACTIVE INGREDIENT – MESALAMINE

Most children with ulcerative colitis are first treated with drugs containing mesalamine, a substance that helps control inflammation such as

  • Sulfasalazine
  • 5 ASAs (e.g., Asacol/Delzicol, Pentasa, Lialda, Apriso, Colazol, Rowasa, Canasa)

The goal of anti-inflammation drugs is to control inflammation. Possible side effects of drugs with mesalamine in them can include nausea, vomiting, heartburn, diarrhea, headache.

CORTISONE OR STEROIDS

(corticosteroids)

While being used less and less as more options become available, cortisone drugs and steroids, or corticosteroids, can be used when your child’s ulcerative colitis is flaring to get symptoms under control quickly.

Corticosteroids are often used for induction therapy. The dosage is lowered once symptoms have been controlled.

These drugs have serious side effects and are not to be used for the long-term management of your child’s ulcerative colitis.

Prednisone is a common generic name of one of the drugs in this group of medications.

Side effects of corticosteroids can include:

  • greater susceptibility to infection
  • increased appetite
  • indigestion
  • increased anxiety
  • mood swings
  • acne
  • osteoporosis or brittle bones
  • hypertension
  • dependence on corticosteroids
  • resistance to corticosteroids
  • weight gain

IMMUNE SYSTEM SUPPRESSORS

These drugs help to suppress your child’s immune system. The most common immune system suppressing drugs are:

  • 6-mercaptopurine or azathioprine
  • methotrexate

Immunosuppressive agents work by blocking the immune reaction that causes inflammation.

At times, your child may be prescribed a combination of

corticosteroids and immunosuppressive drugs.

Researchers find that immunosuppressive drugs may help corticosteroids to work better. If your child is treated with a combination of corticosteroids and immunosuppressive drugs, it is hoped that the dose of corticosteroids can be lowered in order to reduce the risk of your child becoming dependent on them.

Side effects of immunosuppressive drugs can include nausea, vomiting, diarrhea, lowered resistance to infection, pancreatitis.

ANTIBIOTICS

(ampicillin, cephalosporin, tetracycline, metronidazole, ciprofloxacin)

Antibiotics are used to treat toxic megacolon before the colon bursts.

ANTI-DIARRHEAL AND FLUID REPLACEMENTS

(diphenoxylate, loperamide)

Diarrhea, abdominal pain and cramps can get better when the inflammation is under control, but other medication may also be needed to keep these symptoms from coming back.

If your child is dehydrated because of diarrhea, he or she can be treated with fluids and electrolytes.

Nutritional Therapies

If your child’s growth or development is slow, the doctor may recommend nutritional supplements. Special high-calorie drinks can be helpful in this case.

A small number of children may need to be fed intravenously for a short time through a small tube inserted into the vein of the arm. This therapy can help children who need extra nutrition, those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food.

Surgical Therapies

Almost half of patient’s with ulcerative colitis can have surgery at some point in their lives. Surgery may be considered by your child’s gastroenterologist if

  • your child’s ulcerative colitis does not respond well to medications
  • symptoms cannot be controlled by medications or nutritional therapies
  • your child experiences severe bleeding or ruptured colon

Surgical treatments for ulcerative colitis can include a

  • proctocolectomy

this surgery is followed by one of the following surgical procedures

  • ileostomy – removal of the colon and rectum
  • ileoanal anastomosis

that allow waste products to leave the body.

Each child is different, and not every surgical procedure is right for every child. Because a surgical treatment can affect your child and your family’s lifestyle significantly, it is very important to discuss your questions and concerns with your child’s medical team before the surgery. In some cases, you may have access to specialists such as an ostomy nurse or enterostomal therapist who has expertise and experience in counseling and caring for children and families before and after intestinal surgeries. Talking with other patients and parents who have been through surgery for similar problems can also be very helpful and reassuring. A good resource for more general questions or concerns is the United Ostomy Association.

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