Neglect of growth and development in the clinical monitoring of children and teenagers with inflammatory bowel disease: review of case records

The problems of delayed growth and puberty associated with Inflammatory bowel disease (IBD), especially Crohns disease, are well recognised. It is disappointing therefore that Ghosh et al report the continuing failure of optimal anthropometric and nutritional monitoring in children with IBD in Scotland. The poor recording by non paediatric staff highlights the need for these children to be seen by paediatric gastroenterologists and indeed most regions now have at least one specialist to provide such care. Even shared care with yearly review would ensure that this measurement is performed.

In South Wales we provide a regional paediatric gastroenterology service with weekly outpatient clinics at the University Hospital of Wales and outlying clinic visits to other hospitals in the region. In addition children identified with either delayed puberty or growth impairment are reviewed in a joint paediatric gastroenterology/ endocrine clinic held on a 3 monthly basis. We have recently analysed our data on 32 consecutive children (15 male, 17 female) with IBD attending our clinic. A total of 188 outpatient visits (range 1-11 per patient) were recorded between January 1997 and July 1998. On every occasion children had both their weight and height recorded and pubertal staging where necessary. We have previously reported our experience of children with IBD in South Wales where 41% had significant osteopenia in addition to their growth problems. In the light of this our patients now have annual DEXA scans to assess bone density as well as the regular recording of growth data.

Children with IBD deserve full anthropometric and nutritional monitoring in order to reduce unnecessary complications of their disease. Our experience in Wales shows that their management can be most effectively delivered by a tertiary service with both shared care involving local paediatricans/adult gastroenterologists and ready access to endocrinological and dietetic support. We feel it is inappropriate for these children to be cared for solely by adult physicians as monitoring is obviously inadequate to detect complications.

Yours sincerely,

D P Tuthill F Cowan H R Jenkins
Specialist Senior Consultant
Registrar Registrar Gastroenterologist
MRCPCH MRCPCH FRCPCH
(Corresponding
author)