Pediatric patients with IBD as well as adults with childhood-onset IBD are at increased risk for other comorbidities and complications as well. The risk of cancer appears to be particularly high in patients diagnosed with Crohn's disease before 25 years of age and in those with a history of pancolitis.3 Crohn's colitis patients have a risk of adenocarcinoma of the colon that occurs at an incidence 4–20 times greater than that of the general population. Those with disease of the small intestine carry a 50–100 times increased likelihood of developing carcinoma of the small intestine.28 The risk of colorectal cancer in ulcerative colitis is directly related to disease duration, such that there is an incidence of 5% at 20 years and 40% at 35 years among children who develop ulcerative colitis before 15 years of age.47 The safety and efficacy of routine childhood immunizations for vaccine-preventable diseases are a clinical issue in pediatric patients, though recommendations for most children with IBD do not differ from schedules recommended for the general population.48 However, a decrease in immune response to influenza vaccination has been documented among children receiving infliximab and immunomodulatory therapy.49 Finally, the transition of IBD patients from pediatric to adult care is a unique situation that requires time and careful planning.7 Successful transition requires a well-designed transition plan, creation of a current and accessible medical summary, access to continuous health-care insurance coverage, and identification of a healthcare professional who understands the needs of adolescents as they reach adulthood.7,50
