Sibling concerns

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Wow - this is a little like stage fright - I have never shared information like this publicly:eek:. I am mom of recently dx CD 16 yo son - A. (April 2018) but my story starts with his younger brother, now 14.

2012-2014ish we really struggled with nonCD son (then 8-10 years old). He was born with hypotonia. Not terrible, just needed a lot of therapy, and was told he just needed to always be stronger than kids his age, but he will never get worse. One area it affected was the ability to chew and swallow. He actually went to therapy to re-learn how to properly chew. As a result, he became very worried about choking, and what we didn't know was that he was developing an eating disorder. He was hiding his food in his pockets, in empty milk containers, etc. He was a very picky eater, etc. In 2012 when we brought him in for his annual he had not grown or gained weight and was dx failure to thrive. That was when we started to find out about the food hiding, etc. He began therapy, went to nutritional specialist MD and back to the swallow therapist. Over the span of those two years, his food anxiety became really high and he would vomit after eating. He was very restrictive and eventually was only drinking carnation instant breakfast. Which also came up. We hospitalized him in 2014 for several weeks, where he went though an awful but needed eating disorder protocol. It's a difficult thing to go through but it was a matter of taking all food control away from him and slowly give it back. They taught us the Maudsley method, a family based therapy. I won't go into the details but I will say while it worked, there is definitely a detrimental effect to the family. He successfully gained weight that summer and went from full bed restriction to participating in fall sports with no restrictions (It was all based upon weight gain)

In 2016 his older brother - A - started to lose weight. Keep in mind we were still working with his younger brother, and eating around the table was extremely stressful. We thought the stress was bothering his brother. Eventually A began to display similar symptoms (not hungry, worried about eating and occasionally vomiting after getting food in) We ended up switching pediatricians since we did not have an overly receptive one. New pediatrician asked about A's cough, which other ped dx as asthma. He said it was an acid reflux cough. Put on acid reflux med, appetite increaser, and antidepressant. A felt better within days, started gaining weight again and eating.

2017 A became sick with fevers, stomach ache, lethargy, etc. Fevers ended with sores in his mouth. We though Coxsackie virus - he never had it as a kid. He never really recovered from that in hindsight - but we didn't know. He started to lose weight again, became withdrawn (thought teenage issues). Upped the antidepressant (still really low dose) sent to therapy saw a nutritionist. Seemed better but still tired all the time. Loose stool never stopped after the spring virus (not frequent). Stomachaches began in fall through winter, then more cyclical fevers, night sweats this past spring and eventually dx in April with Crohn's.

You all know where I am going now, right?

Every single stomach ache with younger sib I wonder. We thought A had what younger sib had. In fact, A had CD. But maybe this whole time....

Younger sib still doesn't enjoy eating. He does eat and his growth is ok, he is back on his growth line. My exciting news recently was to see his 14 year molars fall out in his 14th year. His teeth were a little behind. We did run blood work recently and all was normal, but low in ferritin...not anemic, all other RBC tests normal. Started him on iron supplements per dr. And he said he would retest in a couple of months. Dr not overly concerned, only put on iron bc I am worried and he knows we have been through the wringer.

I am still worried. Dad is trying to not be. Dad very recently dx with high BP, likely due to all of this.

So, thoughts on what we should do to ease my worrying mind without traumatizing my already traumatized 14 yo?
 
It’s hard when you have mental health issues on top to figure things out
Low iron could be from poor diet

A stool test - fecal caloprotectin
Would look for inflammation in the gut but is not invasive

We went through is it stress or is it ibd for another sibling and how to figure out without going overboard
Early on GI scoped (years ago ) found severe lactose intolerance
But since if the other sibling starts having minor GI distress for a period of time
They will simply draw blood and do a fecal caloprotectin
It’s non invasive for the most part and gives the docs / us piece of mind

Your younger child worked very hard to get to this point
Start simple and watch
Since Crohns kids even when they eat enough
Eventually stop gaining and or growing if they aren’t treated
 
Hello and welcome!
Can I ask you to do something for me - just because I am one of the older moms on here ;). Do both your sons names' start with A? Because if so, then can you call them A1 (older son) and A2 (younger) or come up with nicknames or something? Some people use middle names. That also works.

Because I am getting very confused about who is who. Sorry!!!

So your younger son has issues with eating. But your older son has Crohn's. That sounds very tough. My daughter became severely underweight while being treated for Crohn's and required various feeding tubes and we definitely got a lot of the eating disorder questions since she was a teenage girl, but she essentially was not eating because she was very nauseous and it hurt. She ended up having a combination of Crohn's and Gastroparesis (a motility disorder) so we have learned to work around and she has learned to actually like food.

So that is possible and don't rule that out! She has had every kind of tube possible and was hospitalized MANY times for being underweight. She HATED food - went to college without learning how to cook anything because she simply did not like eating. BOTH your kids may some day learn to like food.

In the last year or two when her weight has been normal and the focus on calories and eating enough has been less intense, she has learned to like and I would even say LOVE food.

So with your younger son, I would also agree with what my little penguin says. A simple Fecal Calprotectin test will tell you if there is gut inflammation. You would also probably want to do other stool tests to rule out infection.

And low iron could easily be from poor diet but could also be from IBD, as I'm sure you know (my daughter with IBD had iron infusions before she was diagnosed with Crohn's).

I think I would keep the whole thing as low stress as possible and consult your older son's GI.

So I think I have your story straight but I'm not entirely sure. Younger son had food issue - restrictive eating disorder.

Older son was thought to have food issues but ended up having Crohn's.

Now younger son has low iron and you are worried.

Is that right?
 
I see, I got it! So K has some belly pain and low iron. Could easily be diet. Stomach pain in the morning - does he eat breakfast? I know a LOT of high school kids do not like eating breakfast - mine certainly did not but were forced to because they had to eat some meds before school which needed to be taken on a full stomach.

So I'll tell you what we did with them - we worked up on breakfast. My younger daughter used to get nauseous eating early in the morning and wouldn't want to eat. So we added food over time. I gave her a scrambled egg and two toasts. For a while she's eat 1/4 of the egg and 1/2 a piece of toast. And slowly we worked up - it took us months. She worked up to a whole egg and two pieces of toast. Or a bowl of oatmeal. And always a cup of tea.

So something like that might be possible for the morning stomach pains - lots of kids have reflux in the morning. I was a high school teacher and always had kids snacking in my classes by second or third period because that's when they're hungry!

Also, iron supplements can cause belly pain... if he's already on them.
 
It sounds odd but he has somewhat of a ritual in the morning. A local company makes chocolate shakes that you can buy bottled. It is dense, high in calories and was an easy solution from back when we were trying to get his weight up. He still to this day has that when he wakes up and does not like if we try to change that. That was all we could get in before school started. Now during the summer he does the shake and then oatmeal or cereal a bit later. We are moving onto egg whites, he hates eggs but will eat the whites. He does say that if he sleeps in his stomach hurts, but feels better after eating. He started the iron a few weeks ago. We wake him up and give it to him early morning bc he drinks milk all day long for the calories and apparently calcium and iron aren't a good mix. So it sounds like all of this could be the source of his stomach aches. I feel much better about this.
 
Iron on an empty stomach
That can cause belly pain big time
Chelated iron is easier on the stomach
But must be taken with food
Even then some guys can’t gandke it

They also make iron drops for infants /toddlers those are suppose to be easier on the belly
Yes we have tried a lot of different iron pills /drops
Most made Ds sick to his stomach so GI just watches his numbers and if ferritin or other numbers gut low enough then infusion
So far we have avoided that

flintstones woth iron
We even tried prenatal ones ;)

Iron rich foods

Some things like ensure powder can be added to his milk
It may have iron added (nutrional complete formula does )
Good luck
 
It could be reflux + the iron supplement. I'd look into that and try to do it without disrupting his routine.

Chocolate itself could cause reflux - my daughter LOVES chocolate more than life itself ;) but it really makes her reflux worse. So that's one other thing to think about.

I would say not to change more than one thing at once. And do the Fecal Calprotectin and other stool tests before making major changes.
 
Welcome, and I'm sorry that your kids and family have been through such hard times over the past years.

I agree that getting a fecal calprotectin test for your younger son would be a good starting point. If you don't want to worry him, just tell him that your doctor routinely tests siblings of kids with Crohn's.

I also agree that iron first thing in the morning on an empty stomach may be causing the stomachaches. We've tried a bunch of iron supplements, and this is the one that seems to cause my kids the least stomach distress:

https://www.amazon.com/Solgar-Gentl...F8&qid=1531589344&sr=8-1&keywords=solgar+iron

I give it to my kids with a vitamin C gummy to help with absorption, but I don't worry about whether they are eating dairy at the same time.
 
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Another vote for fecal calprotectin. It is easy, non evasive and a very good indicator of gut inflammation.

Disordered eating is difficult and a life long journey. Hugs to you and the fam on that one.

It's hard to fight the fight when you don't know what you are fighting. If it is actually CD and you push too much you could set back all the progress you made with disordered eating. Best to do the test and clear the muddy waters although it does sound like his issues could very well be iron a combination of iron supplementation and eating patterns.

Good Luck! Let us know what you find out.
 

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