Growth Failure as the Presenting Symptom of Crohn's Disease

Short stature is a common symptom of Crohn's disease in children, but it is rarely the chief complaint. We have encountered 5 pati?nts whose major complaint was stunted growth and poor weight gain. Only one patient had moderately severe diarrhea, abdominal pain and weight loss, while the remaining patients exhibited mild abdominal symptoms elicited only by probing questions. Bone age was retarded in all. Sedimentation rate was elevated in 3 patients, and 4 had anemia. Small bowel series revealed typical findings of Crohn's disease in all. Two patients had surgical treatment, and 3 received nutritional supplement and steroid therapy. It is concluded that in the patient with stunted growth, careful history taking is essential. A work-up to rule out inflammatory bowel disease is indicated, especially if an elevated sedimentation rate and/or anemia are present, even in the absence of clear-cut abdominal compliants.