Around the time Jennifer Klatt’s son, Matthew, was turning two, she noticed blood in his diaper. She and her husband took him to the doctor. After a series of tests and a referral to a paediatric gastroenterologist, he was diagnosed with Crohn's disease, a kind of inflammatory bowel disease (IBD). “We knew nothing about it. We had never even heard of it,” says Klatt. “We had a lot of tearful nights, looking up drugs and side effects online.”
That was more than a decade ago and, at the time, having a toddler diagnosed with IBD was almost unheard of. Though it’s still very rare, a new study has found that the rate at which children under five are being diagnosed with IBD has been rising substantially every year.
Researchers found that IBD—an umbrella term for two autoimmune diseases of the gut, Crohn’s disease and ulcerative colitis—has risen by an average of 7.2 percent every year between 1999 and 2010. The diseases, which can cause diarrhea, abdominal pain and fatigue, are caused by the body’s immune system attacking the gut. The most common treatment is strong steroids or anti-inflammatory drugs.
The study found that, by 2010, there were 4.5 cases of IBD for every 100,000 kids under age five, and about 38 cases per 100,000 kids up to age 15.
For the Klatts family, even despite catching Matthew’s Crohn’s disease early, the road to recovery was a long one. “Until he was six or seven, we travelled with a potty in the back of the van, so if Matthew had to go right away, we could pull over and he could use it,” says Jennifer. After a number of tests and trying out different drugs, they finally found the right medication for him.
Though IBD is still quite rare in kids, the increase is concerning—partially because researchers don’t know what exactly is driving it. “Something has changed in the last 20 years in children,” says Eric Benchimol, a paediatric gastroenterologist at the Children's Hospital of Eastern Ontario and the lead author of the study.
Researchers aren’t sure why, but Canada has one of the highest rates of IBD in the world. Other northern countries also have high rates, so vitamin D may play a role. Other risk factors include living in a city and having a family history of IBD.
But the most promising theory of what’s driving IBD rates centres around the gut microbiome—the bacteria that lives in the colon and intestines. “The gut microbiome functions in very positive ways to keep our bowel healthy and in check,” says Charles Bernstein, the head of gastroenterology at the University of Manitoba and a prominent IBD researcher. “We think something has gone haywire with the gut microbiome of people with IBD.”
Though they’re not sure exactly what’s gone wrong, they do know that having antibiotics early in life puts kids at a higher risk of IBD. Avoiding unnecessary antibiotics is especially important before age two, since the gut microbiome is pretty much established by that age. So when your doctor prescribes a wait-and-see approach to an ear infection, it’s probably best for your baby’s gut if you don’t push for drugs instead.
Bernstein has ruled out a few bacteria-impacting factors that are not to blame. His research revealed that babies born by C-section are no more likely to develop IBD, nor are babies whose mothers took antibiotics soon before or after their births.
Signs that your child might have IBD include bloody diarrhea, diarrhea that goes on for longer than two or three weeks, and not growing or not gaining weight, says Bernstein. The earlier you diagnose IBD, the better, says Benchimol. That’s because, in those who have it, the immune system attacks the gut, which creates inflammation. Patients are prescribed drugs to stop the inflammation, which should put them in remission. “Kids who are in remission should be able to lead completely normal, healthy lives,” says Benchimol. But if IBD is left untreated for too long, it can lead to scar tissue, which can’t be fixed by drugs and could require surgery.
Matthew is now 13 and still has symptoms if he gets a cold or the flu, or if he eats something he’s not supposed to. But, on the whole, Jennifer says getting him on the right treatment has been a miracle. “He’s 95 percent symptom free.”