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Medical Author:

Andrew B. Grossman, MD

Coauthor:

Petar Mamula, MD

Medical Editor:

Bhupinder Anand, MD

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Crohn's Disease in Children and Teens Symptoms

The symptoms experienced by each person with Crohn's disease are determined mainly by the location and extent of the inflammation.

• As many as 70% of children with the disease have inflammation of the lower part of the ileum. More than half of these children also have inflammation in variable segments of the colon.
  
  
• About 10%-20% of children have inflammation in the colon only.
  
  
• Another 10%-15% have inflammation scattered around the small bowel, mainly in the middle section (jejunum and upper ileum).
  
  
• A very small number have inflammation only in the stomach and the uppermost section of the small intestine where the stomach empties into the bowel (duodenum).

The most common symptoms of Crohn's disease are as follows:

• Small intestine: Watery diarrhea, abdominal pain, weight loss, appetite loss, and slowed growth. Slowed growth may precede other symptoms by several years. Often the symptoms are very subtle.
  
  
• Colon: Bloody diarrhea with mucus or pus, cramping abdominal pain, urgency to defecate
  
  
• Anus/Rectum: Painful defecation, rectal bleeding, rectal pain
  
  
• Upper small intestine: Nausea, vomiting, abdominal pain, poor appetite

Complications of Crohn's disease can lead to more serious problems, both in the intestines and elsewhere in the body. These conditions often cause symptoms.

• Undernourishment: People with Crohn's disease often are undernourished. This happens for several reasons: poor appetite, avoidance of eating because of pain or discomfort, and poor absorption of nutrients by the damaged intestines.
  
  
• Anemia: Symptoms of anemia (a low red blood cell count) include fatigue (feeling tired), malaise (feeling "blah"), shortness of breath, and pallor. Intestinal bleeding can cause anemia. Iron, which is necessary to make red blood cells, is not absorbed as well by damaged intestines.
  
  
• Intestinal damage: Damage to the intestinal wall can lead to the development of abscesses (pockets of infection and pus), strictures (narrowing), obstruction (blockage), perforation (holes in the wall), and fistulas (abnormal connections between the intestine and other parts of the body, or between two parts of the intestine). Children sometimes develop abscesses and fistulas around the anus. This may be the first symptom of Crohn's disease.
  
  
• Colon cancer: The risk of colon cancer is increased slightly in people with Crohn's disease. The cancer usually develops many years after onset of Crohn's disease.

Many people with Crohn's disease have at least one manifestation of the disease outside of the intestine.

• Growth and development problems: Stunted growth and delayed sexual development, or delayed puberty, are common problems in children and teens with Crohn's disease. These problems are believed to be due mostly to undernourishment.
  
  
• Arthritis: Joint pain is the most common manifestation of Crohn's disease outside of the intestines. It usually comes and goes and does not deform the joints. It occurs most often in the large joints of the hips and legs and in the spine.
  
  
• Skin problems: The most common skin manifestation of Crohn's disease is erythema nodosum, which consists of raised, tender, red bumps (nodules), often on the lower legs. This condition is less common in children than in adults.
  
  
• Mouth ulcers: Painful mouth sores may occur during flares of the disease. Occasionally they are the first symptom of the disease.
  
  
• Eye problems: Various parts of the eyes can become irritated, inflamed, and painful. In some cases, this can impair vision.
  
  
• Urinary problems: Crohn's disease can cause problems in the kidneys (stones), ureters (for example, urinary tract infection), and bladder. These often are a result of chemical imbalances related to poor nutrition and absorption.
  
  
• Liver and gallbladder disease: Various liver and gallbladder problems occur in people with Crohn's disease, including hepatitis, fatty liver, gallstones, and inflammation of the bile ducts. In some cases, these are side effects of the treatment rather than of the disease itself.
  
  
• Abnormal blood clotting: People with Crohn's disease have an increased risk of blood clots forming in the blood vessels.

Treatment-related side effects: The potent medications used to control Crohn's disease can affect many body systems, including the liver, gallbladder, pancreas, lungs, heart, and nervous system. Symptoms vary with the medication.