Ulcerative colitis is the inflammation of colon lining. This leads to sores and ulcers which can bleed and cause a lot of pain. They may also cause diarrhea. Ulcerative colitis among children is a chronic condition, requiring management throughout the whole life. Some cases go into remission for months or years, when the child experiences few or no symptoms. But the disease usually keeps coming back during the child’s life. It can, however, be managed through treatment or even surgery. 

What Causes Ulcerative Colitis in Children?

The specific cause of pediatric ulcerative colitis is not known. However, experts associate the following factors with the development of the disease.

1.   Genetic Makeup

Various studies show that 5-20 percent of people with the condition have close relatives such as parents or siblings suffering from a similar condition. This indicates that there is a genetic bearing although the specific gene(s) has not yet been identified conclusively. There is no way of predicting who is likely to develop the disease.

2.   Environmental Factors

Studies carried out on bacteria, viruses and other microorganisms have not yielded any conclusive results and researchers are still working on other microscopic factors.

3.   Inappropriate Auto Immune Reactions

Researchers are still studying to find out if a problem in the immune system, probably stimulated by an environmental factor, may lead to the body turning upon itself.

But some factors have been ruled out. These include dietary factors, anxiety, tension, and personality traits. Ulcerative colitis in children is not a contagious disease.

What Are the Symptoms and Complications of Ulcerative Colitis?

In pediatric ulcerative colitis, the symptoms are not uniform and may range from loose stools, gassy belly and mild pain, to severe pain, loss of weight and bowel movements for more than eight times, sometimes containing blood. Pediatric ulcerative colitis may lead to other health issues, including:

• Severely swollen belly
• Dehydration due to loss of fluids during diarrhea
• Ulceration of the intestines leading to bleeding or even perforation
• Anemia (low levels of red blood cells) resulting from internal bleeding due to ulceration. This may cause constant tiredness.
• Toxic mega-colon due to severe inflammation. This leads to weakening of the intestinal wall which may balloon out, perforate or rupture.
• Slow growth or delayed maturity due to inflammation or the effects of steroid medications that interfere with hormonal functions. This may also happen because the child’s body does not get sufficient nutrients due to poor appetite and loss through diarrhea.
• Elevated risk of colon cancer, especially for children suffering the symptoms for more than 10 years.

Some children may get health problems in other parts of the body, including:

• Arthritis (inflammation of the joints)
• Skin diseases such as psoriasis, pyoderma gangrenosum and erythema nodosum
• Uveitis (inflammation of the eyes)
• Kidney stones
• Gallstones
• Inflammation of the mouth
• Inflammation of the liver and bile ducts
• Depression
• Anxiety disorder
• Blood clots

How to Treat Pediatric Ulcerative Colitis

Treatment of ulcerative colitis in children depends on the symptoms, age and health status. It includes the following options.

1.   Diet

While there are no diet guidelines in the treatment of the disease, it helps to avoid foods that upset the child’s stomach.

2.   Medication

Your child’s doctor may give a prescription of medications to fight inflammation, such as corticosteroids and aminosalicylate. If the symptoms are severe, the doctor may prescribe antibiotics, steroids and immunomodulators.

3.   Hospitalization

If the child’s symptoms are severe, hospitalization may be necessary for further management including control of diarrhea, intravenous feeding or even surgery.

4.   Surgery

Between 4 and 25 percent of cases of ulcerative colitis in children eventually require surgery as a result of excess bleeding, perforation of the colon, severe illness or risk of cancer. It may also be done if other treatment methods don’t work. Surgery involves the removal of the colon using one of the following procedures:

• Proctocolectomy with Ileostomy

In this procedure, the whole colon including the rectum is removed and an opening is made in the abdominal wall to drain waste from the gut. 

• Ileanal Anastomosis

In this procedure, only the affected part of the colon is removed. The remaining part, including the rectum, is attached to the ileum to form a pouch to hold waste. The child will then pass the waste through the anus, although this may happen more often. The waste will also be more watery.

5.   Follow-up Treatment 

Follow-up is critical for the child’s healthcare provider to do the things.

• Confirm that prescribed medication works well.
• Identify any side effects of the medicine.
• Monitor the child’s growth.
• Carry out blood analysis to ensure healthy blood chemistry.

Bone scan is also recommended to ensure the child’s bones are not weak. Additionally, the child should get regular eye checkups.

When to Go for Follow-up Appointments

This will depend on the individual child, the treatment plan in place and the child’s condition.

• For a child who is doing well and free from symptoms, the doctor may recommend an appointment every six months.
• For a child on immunosuppressants, the doctor may recommend an appointment every three months due to the higher risk of complications.
• If the child is unwell, the doctor may recommend a monthly appointment.

When to Call the Doctor

It is critical to call your child’s doctor in case of the following:

• Body temperature higher than 101 °F
• Increased number of daily bowel movements
• Increased stomach pain or cramping that won’t stop
• Change in the consistency of the child’s stool
• Blood in the child’s stool or change in its amount
• New pain in the rectum
• Bleeding in the rectum
• Vomiting for more than 3 to 4 hours
• Vomit containing bile (yellowish or greenish)
• Bloating
• Excess and chronic tiredness
• A rash on lower legs
• Joint pain or swelling
• Red or swollen eyes

Always bear in mind that you know your child better than anyone. Look out for any signs or symptoms of ulcerative colitis, and if something worries you, call your child’s doctor immediately.