Crohn's Disease In Children Crohn's disease is a devastating chronic illness which can develop during childhood.
It is an inflammatory disease which can involve any segment of the gastrointestinal tract.
The exact cause of the disease is not known, but it involves an immune reaction of the body to its own gastrointestinal tract.
There is currently no known cure for Crohn's disease.
Crohn's disease affects an estimated two hundred thousand children and teenagers in the United States.
This inflammatory disease has been detected in children as young as 18 months of age.
Crohn's disease (CD) occurs more frequently in people of European descent, in whites, and in Ashkenazi Jews.
There is a genetic predisposition to develop CD, and 30% of young patients have a family history of the disease.
If both parents have an inflammatory bowel disease, such as Crohn's disease, 50% of their children will develop the illness by the age of 20.
SYMPTOMS OF CROHN'S DISEASE
Decreased appetite and weight loss.
Vague abdominal pain, and irregular bowel movements.
Diarrhea.
Fatigue related to anemia and pain.
GENERAL SIGNS OF CROHN'S DISEASE
Low grade fever.
Occult blood loss.
Anemia.
Growth retardation in children.
BASIS FOR DIAGNOSIS
Diagnostic colonoscopy, or contrast radiography - showing a "cobblestone" type of lining of the gastrointestinal tract.
Oral or gastrointestinal biopsy showing noncaseating sterile granulomas.
Medical lab tests - such as CBC, differential, and ESR.
ORAL MANIFESTATIONS OF CROHN'S DISEASE
Cobblestone appearance of the oral mucosa.
Persistent lip swelling.
Vertical fissures on the lips.
Redness around the mouth (perioral erythema).
Enlargement of the lymph nodes (cervicofacial lymphadenopathy).
Anti-inflammatory therapy works for 50-60% of moderately ill patients (5-aminosalicylate products, and/or prednisone).
Diet alteration.
Surgical resection (66-75% of children with CD will need one or more operations of the gastrointestinal tract).
A case report of Crohn's disease was recently published in the NEJM:
Stricker T, Braegger CP: Oral manifestations of Crohn's disease. The New England Journal of Medicine. June 1, 2000, Vol 342, No 22.
What Is Munchausen Syndrome By Proxy? Munchausen syndrome by proxy (MSBP) is a form of child abuse in which the perpetrator, usually the mother, fabricates or induces illness in a child.
These fabricated symptoms cause the physician to perform unnecessary diagnostic procedures for the child which do not result in a diagnosis.
The term MSBP describes a form of child abuse which is difficult to detect, because the perpetrator is usually skilled at deceiving health professionals.
Mortality rates for child-victims can be as high as 10%.
Munchausen syndrome by proxy was first described in 1977 by the English physician Roy Meadow.
The term was adapted from Munchausen syndrome, first described by Asher in 1951, in which adults presented false histories of illness to their physicians.
PROFILE OF THE VICTIM
Age: 15 months to 6 years. Average 26 months.
Race: caucasian.
PROFILE OF THE PERPETRATOR
Usually the mother.
Mother puts her need to be in an "illness attention-getting role" ahead of her child's needs.
Mother is inordinately attached to her child.
Mother has an inordinate familiarity with the hospital's medical staff.
Mother seems to thrive on the pediatric ward.
Mother seems eager to have invasive medical tests performed on her child.
Mother has a history of health care work.
Mother is around 24 years old.
RED FLAGS FOR MSBP ABUSE
Only the mother has observed the fabricated symptoms of the child.
The fabricated illness is unusual.
The father is notably absent from the hospital.
Another child from the same family has died from SIDS.
Laboratory tests do not confirm the alleged illness.
WHAT MSBP IS NOT
Physical child abuse which is covered-up.
Child neglect, or failure to thrive.
When the mother has delusions about her child's illness.
When the mother does everything possible to keep her child dependent on her.
When the mother causes her child be believe that both of them have the same factitious illness.
When the mother engages in doctor shopping merely to obtain a number of different opinions.
When the mother treats her child as if it were ill or disabled, and confines the child to a bed or wheel chair.
A study recently published in Pediatrics evaluated the use of covert video surveillance (CVS) in diagnosing Munchausen syndrome by proxy abuse in a tertiary care children's hospital.
A diagnosis of MSBP abuse was made in 23 of the 41 patients monitored.
In 4 patients, CVS was actually used to establish the innocence of the parents.
The study found that the stereotyped profile of a MSBP mother is by itself not sensitive enough for use in diagnosing this type of abuse.
The study concluded that "CVS is required to make a definitive and timely diagnosis in most cases of MSBP."
Hall DE, Eubanks L, Meyyazhagan S, Kenney RD, Johnson SC: Evaluation of covert video surveillance in the diagnosis of Munchausen syndrome by proxy: lessons from 41 cases.
Pediatrics. June 2000; 105:1305-1312.
Protecting Children From The Sun Excessive sun exposure during childhood has been associated with the development of skin cancer in adults.
Each year, more than 1 million cases of skin cancer are diagnosed in the United States, and one person dies every hour from melanoma or nonmelanoma skin cancer.
According to the American Cancer Society about 44,200 new cases of melanoma and 7,300 deaths are reported each year.
Melanoma is a form of skin cancer that arises in melanocytes - the cells that produce melanin pigment found in the skin.
Melanoma is a serious type of skin cancer, because it can spread to other parts of the body.
Approximately 80% of lifetime sun exposure occurs before the age of 18.
Excessive exposure to the sun is associated with the development of nevi (moles) in children.
A nevus is a benign growth of the skin.
Most children develop nevi by their first birthday.
The number of nevi increases with age, tapering off around the age of 15.
Children with light skin who are prone to sunburn tend to have more nevi.
Nevi occur more frequently on sun-exposed areas of the body.
High nevus (mole) density on the skin is a risk factor for the development of malignant melanoma later in life.
A mole is a cluster of pigment-producing cells and supporting tissue that can appear as tan, brown, or flesh-colored spots on the skin.
Moles can be flat or raised.
They can be round or ovoid in shape, and are usually no wider than a pencil eraser.
Most people have between 10 to 40 moles on their body.
Sunlight is composed of heat, visible light, "below violet" radiation, and invisible ultraviolet radiation (UVR).
UV radiation can damage the skin and cause melanoma and other types of skin cancer.
UV radiation that reaches the earth is made up of UVA and UVB rays.
UVB constitutes less than 0.5% of the sunlight reaching the earth, but is responsible for much of the skin damage that can lead to skin cancer.
TIPS FOR PROTECTING CHILDREN
Seek shade.
Avoid the midday sun as much as possible.
The sun's UV rays are strongest between 10 a.m. and 4 p.m.
Pay attention to your local UV index.
Look for it in the weather section of your newspaper, or during your local television station's weather report.
Wear sunglasses that block 99% of UV radiation.
Slap on a hat.
It should shade the face, eyes, and neck.
Slip on full-length clothing.
For maximum protection, choose tightly-woven, loose-fitting clothes which protect the arms and legs of children.
Slop on a broad-spectrum sunscreen before going outside.
Apply liberally.
Reapply after swimming or sweating.
Use a sunscreen with an SPF (sun protection factor) of 30 or higher. Make sure the face is covered.
The EPA (Environmental Protection Agency) is working with schools and communities in the United States to launch the SunWise School Program.
SunWise teaches children in elementary school how to protect themselves from the sun.
Since children tend to spend more time outdoors than adults, they are at higher risk for developing UV-related health problems.
For additional information about SunWise, contact the EPA at 1-800-296-1996.
Ask for A Guide to Sun Wise Behavior, booklet number EPA430-K-99-035 .
A study recently published in JAMA concluded that broad-spectrum sunscreens may reduce the number of new nevi in white children, especially if they have freckles.
This study was the first-ever randomized trial of the use of sunscreen as a chemoprotective agent for attenuating the development of nevi in children.
The nevi (moles) can be precursors to skin cancer later in life.
Gallagher RP, Rivers JK, Lee TK, Bajdik CD, McLean DI, Coldman AJ: Broad-spectrum sunscreen use and the development of new nevi in white children. JAMA. June 14 2000; Vol 283:2955-2960.
