The treatment of Crohn’s Disease in children requires special attention and differs in some aspects from therapy in adults. This article summarizes the most important recommendations and special considerations.
First-Line Therapy: Exclusive Enteral Nutrition (EEN)
Exclusive enteral nutrition (EEN) is strongly recommended as the first-line therapy for children with Crohn’s Disease:
- Equivalent remission rates
- Better mucosal healing
- Positive effect on growth
- Effectiveness even with repeated use (up to 80%)
Notably, EEN is effective regardless of the disease pattern and is thus suitable for various manifestations of Crohn’s Disease in children.
Immunosuppressive and Biologic Therapy
For moderate to severe cases, early use of immunosuppressants or biologics is recommended. Options include:
- Azathioprine (with proven steroid-sparing effect)
- Methotrexate
- TNF-α antibodies
Special considerations in application:
- Proactive drug monitoring is considered beneficial
- For children under 30 kg body weight or with extensive involvement, higher doses or shorter intervals may be necessary
- When using Infliximab, a 6-12 month combination with immunosuppressants is recommended
- Caution is advised when using thiopurines due to an increased risk of malignancy, especially in EBV-negative patients
Surgical Therapy
Early surgical intervention should be considered in cases of:
- Growth delay
- Localized involvement
- Therapy resistance
Surgical therapy can have a steroid-sparing effect and promote growth.
Growth and Development
Special attention is given to the growth and development of young patients:
- Growth hormones are not recommended for delayed puberty
- Long-term steroid therapy should be avoided due to its growth-inhibiting effect
- In mild ileocecal involvement, budesonide may be considered instead of prednisolone
- Mesalazine is not recommended
Special Challenges
Growth Disorders
About one-third of pediatric patients with Crohn’s Disease suffer from growth disorders. These depend on:
- Time of disease onset
- Disease activity
- Disease duration
- Malnutrition
- Steroid effects
Special Therapeutic Considerations in Childhood
The treatment of children with Crohn’s Disease requires special adjustments:
- Careful adjustment of medication dosage
- Consideration of developmental aspects
- Inclusion of psychosocial factors
- Special measures to promote therapy adherence (compliance)
In summary, the treatment of Crohn’s Disease in children requires a multidisciplinary approach that considers both the specific needs of the growing organism and the psychosocial aspects of chronic illness. Exclusive enteral nutrition as the first choice, followed by carefully considered immunosuppressive or biologic therapy, forms the backbone of treatment. Surgical interventions can play an important role in certain cases. The goal should always be to support the child’s growth and development as best as possible while effectively controlling disease activity.