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Column originally published Jan 8, 2002

Toddler’s Diarrhoea Is More Likely In A Small Child Instead Of Crohn’s Disease

Question: I have Crohn's disease for several years. With careful management and medications, I am doing very well. Now, I am worried about our two-year-old son. He is generally healthy, but every few days he would have some runny stool. Otherwise he seems to be growing well. Should I worry that he may develop Crohn's disease also?


You have a very good question, and I understand why you are concerned. Before I give you the answer, I would like to explain a little about Crohn’s disease so that other parents can understand this medical condition.

Crohn’s disease is an inflammatory condition of the intestines. It was first reported in medical literature in 1761, although there was little known about this until the last few decades. In spite of intensive research, we still don’t have full understanding of the cause of Crohn’s disease, and why it affects some people but not others.

Crohn’s disease can involve any part of the gastro-intestinal tract—from the mouth to the anus. In this way, it differs from ulcerative colitis, another inflammatory condition of the bowel which affects mostly the large intestines. These two medical conditions (Crohn’s disease and ulcerative colitis) are also called ‘inflammatory bowel disease’ (IBD).

In North America, Crohn’s disease affects 30-100 people per 100,000 population. By studying the disease in different populations, researchers have found a definite link between Crohn’s disease and the genes. It appears that Jews are more frequently affected than any other ethnic groups. In identical twins, if one develops Crohn’s disease, the second twin has a 50% chance of having the same illness sooner or later, which is a much greater chance than the general population. There is also a significantly increased chance of Crohn’s disease in siblings and children of those suffering from this condition.

By analysing disease patterns in families, it is speculated that several genes are involved in Crohn’s disease. However, these genes have not yet been identified.

Again, research also showed that the incidence of Crohn’s disease is increasing world-wide in the past few decades. The exact reason is still unknown, although environmental factors may be the culprit. Over the next one or two decades, we hope we can understand this condition much better.

Crohn’s disease afflicts both males and females, mostly commonly those in their late teens and twenties. The majority of them have inflammation of the lower part of small intestines and first part of large intestines. As a result, the most common early symptom is pain on the right side of the abdomen. Diarrhoea and low grade fever are also common. These symptoms can be confused with those of appendicitis.

The lumen of the intestines becomes narrowed as a result of inflammation. Over time, scarring can lead to stricture of the intestines. Both the inflammation and stricture can produce symptoms of intestinal obstruction: repeated vomiting, fullness in the abdomen, and lack of stool. Inflammation can be controlled by medicine, but stricture would require surgery.

Another fairly common problem in Crohn’s disease is formation of abscess around the anus (this is called perianal abscess). This infection usually cause severe localized pain, and requires drainage of the abscess. A number of other complications can also occur, but it is beyond the scope of this column to discuss them.

The diagnosis of Crohn’s disease depends on the demonstration of inflammation in the intestines. This can be done by X-ray (called Barium meal and follow-through) or by endoscopy. Blood tests can also detect signs of inflammation in the body. Because of inflammation, bleeding in the intestines is very common, although most of the time it is microscopic and can only be detected by special test on the stool (this is called ‘occult blood’ test).

I should mention here that certain bacteria (as well as some parasites and viruses) can cause abdominal pain, diarrhoea, and bleeding. It is important to rule out infection as the cause of problem by doing appropriate stool tests.

As you already know, once the diagnosis is confirmed, medicine can usually keep the inflammation under control. Because Crohn’s disease is a chronic condition, medications are required for a long time. Presently there is no cure for this condition because we still don’t understand the underlying cause.

Your concern of Crohn’s disease in your son is legitimate. With your history of illness, your son may carry the genes that will ultimately lead to the same illness. However, it is very uncommon for children to develop Crohn’s disease at two years of age. Children with Crohn’s disease often have weight loss, reduced growth in height, and lack of energy weeks to months before they develop abdominal pain and diarrhoea. Low grade fever is also very common. When tested, their haemoglobin is often reduced because of bleeding in the intestines.

The more likely problem in your son is ‘toddler’s diarrhoea.’ This condition is caused by excessive consumption of sugars that he cannot digest. These sugars are mostly present in juices. When these natural sugars overwhelm the small intestine’s ability to digest and absorb, excess sugars are broken down by normal bacteria in the intestines. All these will lead to diarrhoea. The problem can happen daily, or intermittently, depending on the amount of sugar that is consumed.

As long as your son is healthy and growing well, you can relax. However, he should be followed by your family doctor or paediatrician regularly to make sure he continues to gain in weight and height. If there is any concern, a few simple blood and stool tests can be done to look for signs of inflammation and bleeding.

I hope this information will relieve some of your worries. Good luck!