UC and Children
Although most people with IBD are diagnosed after 20 years of age, the incidence of IBD in children and adolescents appears to be increasing. It is estimated that of the 1 million individuals living with IBD in the US, approximately 100,000 are under the age of 18. Furthermore, about 25% of people will develop their first symptoms in adolescence before coming to diagnosis. There are a variety of aspects of IBD in the young that differ from that in adults:
Relationship to age
The peak onset of IBD in children is typically during adolescence between 12-15 years. It can, however, develop as early as the first year of life. An interesting observation that has been made in several studies is that UC and indeterminate colitis tend to predominate in the youngest patients (< 5 years of age). As children approach adolescence, Crohn's disease becomes more common.
Growth and puberty
Chronic disease during adolescence can impact the attainment of one's genetic height potential and delay pubertal development. Numerous studies have demonstrated that children with IBD are at risk of growth and pubertal problems, albeit more so for Crohn's than UC. Growth and pubertal delay result from a combination of inflammation in the body, malnutrition from poor gut absorption/ lack of appetite, and steroid side effects. Generally once the disease process is controlled, growth and pubertal development resume as normal.
Social and emotional development
Adolescence is a key time of both social and emotional development. Teens are faced with the tasks of developing autonomy and self-image. Coping with a chronic illness like IBD during this period in life can be especially stressful. It is a time when children most want to fit in with their peers, but their health problems may make them feel like they are worlds apart from others. They may feel uncomfortable talking about what they are going though even with family or close friends. Parents and physicians caring for teens with IBD need to pay particular attention for signs suggesting certain children could need additional emotional support
Future risk for colon cancer
The risk of colon cancer in UC is believed to be related to duration of disease, extent of disease through the colon, associated primary sclerosing cholangitis (PSC), as well as chronic inflammation. Thus, the longer one has the disease and the more active and extensive it is, the greater the risk of developing colon cancer. This is an important consideration for people diagnosed at a young age. For UC patients without PSC, it is recommended that routine colonoscopies are performed starting 8 years after diagnosis. Colonoscopies are then performed every 1-3 years depending on associated risks for the patient. Because there is a greater risk of colon cancer in patients with UC and PSC, colonoscopies are performed at diagnosis and then yearly in such individuals.