Reversal of growth retardation in Crohn's disease with therapy emphasizing oral nutritional restitution

Seven children with Crohn's disease and growth retardation responded to therapy which focused upon oral nutritional restitution and maintainence. The study population included children whose disease activity varied from mild to severe, but patients who were receiving daily suppressive doses of corticosteroids were not included. Diet counselling and supplementation were designed to reverse the prominent deficit in caloric intake which was characteristic of each patient before therapy. An increase in caloric intake from 1535 +/- 148 kcal/day to 2493 +/- 108 kcal/day (a change from 56% to 91% of that recommended for height age and sex) was achieved. Five patients increased growth velocity from a mean of 1.8 cm/yr to a mean of 6.2 cm/yr after drug therapy and oral nutritional supplementation. In 2 other patients, oral nutritional therapy was supplemented for a period of 4 wk by peripheral intravenous nutrition; growth velocity in these patients increased from < 2.0 cm/24 mo to 4.2-6.5 cm in the subsequent 12 mo. All patients showed an increase in height percentile with 5 of 7 patients reaching within 5% of their preillness height percentile. These results emphasize the importance of nutritional restitution in restoring growth in children with Crohn's disease and provide a promising approach to the treatment and prevention of growth retardation in many of these children.