UC in Very Young Patients (<5-8years)
Christine wrote into the blog with concerns pertaining to her young grandchild with colitis. The peak onset of IBD in children typically occurs between 10-15 years of age. Children with the onset of IBD at ages less than 5-8 years fall into a unique category of patients. Studies of these very young IBD patients (< 5-8 yrs) have shown that there is a predominance of colonic involvement of disease. Furthermore, distinguishing between Crohn's disease and UC can be particularly challenging in this age group. Fifteen to 30% are diagnosed with "indeterminate colitis," which is a form of IBD carrying features of both Crohn's and UC. Symptoms of UC in the very young are similar to those of older children and adults, consisting of diarrhea, blood in the stool, and abdominal pain. Just as in older patients, the disease course in the very young varies considerably. The unpredictable nature of IBD is perhaps one of the most frustrating aspects of the condition for both patients and physicians. The treatment goals are to induce remission of disease and find an acceptable maintenance agent to keep disease quiescent and minimize untoward side effects. Unfortunately, there is a paucity of data regarding response to therapy in this age group. Studies of colectomy rates in this age group have suggested that 5-20% will require removal of the colon in the first few years of disease.
Christine also commented on her own feelings of frustration and helplessness with respect to her grandchild's illness. When children have a chronic medical condition, it affects the entire family. Many parents describe feeling a loss of control over life when their child falls ill. As it is human nature to want to care for and protect young children, there is a strong emotional investment from the entire family unit. Christine notes in her email family disgareement regarding the course of her loved one's therapy. Finding ways to discuss these issues rationally in a non-confrontational manner is key. In these situations, bonding together in a cohesive, supportive manner is in the best interest in the child and family members.