Symposium 6: Young people, artificial nutrition and transitional care Nutrition, growth and puberty in children and adolescents with Crohn's disease

Abstract

Of the individuals who present with Crohn's disease 25% are <18 years of age, mostly adolescent. Nutritional impairment and delayed growth are common at diagnosis and remain an issue during the disease course. Treatment has the primary aim to control symptoms, induce disease remission and achieve normal growth in the long term and includes nutritional support and early use of immunomodulation. Puberty may be discordant and is generally late and final adult height may not be achieved until the late teenage years. Chronic ill health and delayed growth may be accompanied by emotional and intellectual immaturity. These factors, including the varying rates of physical and emotional development, need to be considered during adolescence with multidisciplinary input to ensure that the young patient is appropriately supported. Transition to adult care requires close collaboration between paediatric and healthcare teams with careful attention to nutritional, emotional and educational issues, all of which are relevant in the progression from childhood, through adolescence and to adult life.

Introduction to and Screening Visit Results of the Multicenter Pediatric Crohn’s Disease Growth Study

“…24,25 In our earlier single-center, cross-sectional study of pediatric CD patients, mean BA Z scores (BA results standardized for sex and chronological age [CA]) ( Table 1) were lower in females, 24 raising the possibility of greater potential for catch-up growth once in remission in females and therefore less growth impairment in females. Chronological age at menarche was later in children with CD than healthy children, 26 supporting delayed puberty in females with CD 27 .…”

Graduation Day: Healthcare Transition From Pediatric to Adult

“…With increased survivorship for patients with POCC comes an increased number of transition patients who lack the capacity to exercise full autonomy and privacy with respect to healthcare decisions. Beattie highlighted the need for individualized considerations for those with SHCN and delayed growth because these may be accompanied by emotional and intellectual immaturity. Careful attention to nutrition, emotional, and educational issues are all relevant in the progression from childhood through adolescence to adulthood.…”

Pediatric Crohn's disease: epidemiology and emerging treatment options

“…Maintenance of clinical response with long-term biological therapy in children is accompanied by normal growth, progression through puberty, and optimized skeletal health, as well as the resolution of symptoms that can have a profound impact on quality of life and psychosexual well-being and development. [107][108][109][110] Loss of response to the biological can represent a disaster for any patient, but particularly for a growing and maturing child or adolescent. It is believed that the most likely cause of secondary loss of response is the development of antibodies to the biologic agent.…”