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Published on: October 14, 2025
Growth abnormalities persist in newly diagnosed children with crohn disease despite current treatment paradigms
Marian Pfefferkorn1, Georgine Burke, Anne Griffiths
1Riley Hospital for Children, Indianapolis, IN 46202, USA. mdelrosa@iupui.edu
Insights
Growth delay persists in many children with Crohn disease (CD) despite current therapies. New strategies are needed to improve growth outcomes for pediatric CD patients.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Inflammatory Bowel Disease Research
Background:
- Crohn disease (CD) is a chronic inflammatory condition affecting the gastrointestinal tract.
- Growth abnormalities are a significant concern in pediatric patients with CD.
- Current therapies aim to control inflammation and improve quality of life, but their impact on growth requires ongoing evaluation.
Purpose of the Study:
- To analyze growth outcomes in children newly diagnosed with Crohn disease.
- To determine if growth abnormalities persist despite current therapeutic interventions.
- To identify factors associated with impaired growth in pediatric CD.
Main Methods:
- Prospective cohort study of children under 16 years old at diagnosis with Tanner stage I-III.
- Collection of clinical and growth data, including height z scores and height velocity z scores.
- Analysis of treatment modalities, including immunomodulators, corticosteroids, 5-aminosalicylates, infliximab, and enteral nutrition.
Main Results:
- 176 children were studied; mean age 10.1 years, 65% male.
- At 2 years, mean height z scores were -0.46 +/- 1.1 SD; 6.5% had height z scores < -2 SD.
- Abnormal height velocity at 1 year was associated with corticosteroid use > 6 months (aOR=4.5; 95% CI=2.2-9.6).
- Mean height velocity z score improved from -0.71 at 1 year to 0.26 at 2 years (P < 0.03).
Conclusions:
- Growth delay remains a challenge for many children with Crohn disease, even with improved disease control and advanced therapies.
- Current treatments, including immunomodulators and biologics, do not fully resolve growth issues in all pediatric CD patients.
- Development of novel strategies is essential to effectively address and improve growth outcomes in this population.
Objectives:
We analyzed growth outcomes in children newly diagnosed with Crohn disease and determined whether growth abnormalities persist despite current therapies.
Patients And Methods:
Clinical and growth data were prospectively obtained on an inception cohort younger than 16 years old at diagnosis and Tanner I to III during the study.
Results:
In all, 176 children (mean age 10.1 years; 65% male) with mild (33%) or moderate/severe (67%) disease at diagnosis were studied. Disease activity at 1 year was inactive/mild (89%) or moderate/severe (11%). First-year treatments included immunomodulators (60%), corticosteroids (77%), 5-aminosalicylates (61%), infliximab (15%), and enteral nutrition (10%). By 2 years, 86% had received immunomodulators and 36% infliximab. Mean height z scores at diagnosis, 1 year, and 2 years were -0.49 +/- 1.2 standard deviations (SDs), -0.50 +/- 1.2, and -0.46 +/- 1.1, respectively. Of the subjects, 10%, 8%, and 6.5% had height z scores less than -2 SD at diagnosis, 1 year, and 2 years. A height velocity z score less than -1SD was seen in 45% of subjects at 1 year and 38% at 2 years. The mean height velocity z score, however, increased between 1 and 2 years from -0.71 to 0.26 (P < 0.03). Corticosteroid use greater than 6 months in the first year was associated with abnormal height velocity at 1 year (adjusted odds ratio = 4.5; 95% confidence interval [CI] = 2.2-9.6). No statistically significant effect on height velocity z scores was noted when comparing those receiving or not receiving infliximab.
Conclusions:
Growth delay persists in many children with CD following diagnosis, despite improved disease activity and the frequent use of immunomodulators and biologics. Additional strategies to improve growth outcomes require development.
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