Easter, Seder Foods Not for Kids With Crohn's

For most parents, the spring holidays are a time of food and festivities for their children. The biggest worry these parents have to deal with are tummy aches from kids overstuffing themselves on Easter dinner and candy or tummy grumbling when their kids don’t want to eat the gefilte fish and matzah associated with Passover.

Those worries are nothing compared to what parents struggle with when their children suffer from chronic intestinal conditions, such as Crohn’s disease and ulcerative colitis. For them, this holiday season is a time of anxiety and desperate hope that their child’s condition will not worsen. Food choices become a major challenge.

Both Crohn’s disease and ulcerative colitis are types of Inflammatory Bowel Disease (IBD), a set of disorders that cause the immune system to activate inappropriately and attack healthy tissue in the small and/or large intestines.

Children with IBD often have to limit their intake of high residue foods, such as corn, popcorn and tortilla chips, as well as seeds, nuts and caffeine (soda, chocolate). The issue is not related to whether kids with IBD can absorb these foods. They definitely can. But, eating them often makes symptoms much worse.

In the case of Easter, children with IBD can eat chocolate in very limited amounts, and overeating at dinner can cause much more than a simple tummy ache. With Passover, these children have to limit their matzah intake, because it tends to soak up fluids in the intestines and cause constipation. For children whose diets are already limited, imposing even more limitations can cause stress for the family.

The number of children with IBD has increased dramatically over the past 25 years, further dispelling the myth that these are “adult” conditions. Nearly one-third of all patients with Crohn’s Disease are diagnosed at an age younger than 20 years. Most of them are between 10 and 20, and some are younger than five years.

Complicating matters is the fact that Crohn’s and colitis are difficult to diagnose. The symptoms can be as generic as abdominal pain and slower growth. However, as the disease progresses, children experience more recognizable symptoms, such as:

• Severe abdominal cramping
• Persistent diarrhea
• Constipation
• Fever
• Fatigue
• Weight loss
• Rectal bleeding

By tracking symptoms, combined with blood testing and a number of GI tests, we can determine if a child does, indeed, have Crohn’s or colitis and begin treatment. These conditions have no cure, so our focus is to provide treatment that reduces symptoms to a point of remission. There have been tremendous advances in the medications available to treat IBD over the past few years, putting remission rates in children with IBD at an all time high!  At Advocate Lutheran General Children’s Hospital’s Center for Children’s Digestive Health, we care for more children with Crohn’s Disease and ulcerative colitis than any other institution in Illinois.

Despite improvements in medications and a growing awareness of what needs to happen to make kids better, there is also the reality that these patients are not small adults.  They are still kids. They tire of their routine and miss appointments. Parents grow weary of saying no to foods that other kids can have and allow exceptions.

Our participation as a member of an organization called Improve Care Now (www.improvecarenow.org) has helped us improve the quality of care for children with these conditions. We use best practices that include customized care plans, checks and balances and testing to determine the best medications, food choices and lifestyle habits for each child.  Today, the remission rate for children in our community is almost 75%--an incredible rate, when you consider that a 50% remission rate used to be considered good.

Using this quality improvement model, it may be possible in the future to improve care for patients with any number of chronic conditions. In the meantime, we will continue to help make the lives of our pediatric patients with IBD more enjoyable, and their parents less stressed, even during a time of year when food is the focus.

James Berman, M.D., is with theCenter for Children’s Digestive Health at Advocate Lutheran General Children’s Hospital and a Clinical Associate Professor of Pediatrics at Loyola University School of Medicine.

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