Pediatric Remicade infusions

What are Pediatric Remicade infusions?

Remicade® (infliximab or inflectra) is a medication that treats children six years and older with inflammatory bowel diseases (IBD), like ulcerative colitis (UC) and Crohn’s disease. IBD happens when the immune system mistakenly attacks the gut as if it were a harmful bacteria, causing too much inflammation. Remicade slows down this immune system response and controls inflammation. This helps reduce IBD symptoms and can lead to remission — a period of time where children are symptom free.

We administer Remicade through an IV, which involves inserting a small needle and flexible tube to connect to a vein. Children receive an initial series of three treatments that take four hours per treatment. Once the introduction treatments are complete, kids receive routine treatments about every eight weeks that take about one hour per treatment.

What are the benefits of pediatric Remicade infusions?

IBD can be quite taxing on kids. Living with miserable IBD symptoms can affect their overall quality of life, preventing them from going to school and doing activities like sports or playing with friends.

• Remicade offers major health benefits because it can reduce IBD symptoms, encourage and maintain remission, promote healing in the GI tract and reduce the need for other IBD medications, like steroids.
• Remicade can also help prevent serious IBD complications, such as infected passageways (fistula and abscesses) and narrowing or blockage inside the GI tract.

Our GI team at Children’s Health is happy to offer an effective treatment to kids with IBD so they can go back to school and enjoy the daily activities they love.

What are the side effects of pediatric Remicade infusions?

Remicade infusions can cause mild to severe side effects that can occur during treatment or appear within 14 days after infusion. Regardless of the type of symptoms, call your child’s pediatrician and GI doctor so they can treat any serious side effects and adjust your child’s Remicade dosage.

The most common symptoms include:

• Redness or pain at IV site
• Tiredness
• Headache
• Stomach pain
• Joint pain
• Nausea/vomiting
• Fever
• Sore throat
• Cough
• Ear infection
• Skin infection
• Rash

Serious side effects may include:

• Shortness of breath, wheezing or trouble breathing
• Fast or slow heartbeat
• High or low blood pressure
• Swelling of ankles or feet
• Severe dizziness
• Fainting

All remicade treatments are performed at Children’s Health’s infusion center so we can closely monitor your child during their infusion and give medical care if a severe reaction occurs.

What are the risks of pediatric Remicade infusions?

While Remicade helps to bring an overactive immune system under control in children with inflammatory bowel disease, it does come with some risks.

Fortunately, these risks are rare but include:

• Severe allergic reaction (anaphylaxis)
• Pneumonia
• Tuberculosis (TB)
• Colon cancer
• Small intestinal cancer
• Skin cancer
• Lymphoma

To reduce the risks of severe infection, we recommend that children be up-to-date with their vaccinations, including pneumococcal vaccination. We also check for tuberculosis before we start Remicade treatments and repeat these tests every year to make sure your child hasn’t developed TB.

Hearing that any medication your child is taking increases their risk of developing cancer can be scary but these risks are extremely rare. The risk of developing colon or small intestinal cancer while on Remicade is much lower than the cancer risk children face if IBD is left untreated. We also recommend that children be screened for skin cancer once every two years by a dermatologist.

What are Children’s Health’s outcome metrics for pediatric Remicade infusions?

Pediatric Remicade infusions have a high success rate; about eight out of ten children start feeling better within 2-14 days after their first infusion. For most kids, IBD becomes an afterthought because they experience such a dramatic reduction in their symptoms and enter into remission.

What to expect with pediatric Remicade infusions

There is little preparation needed for Remicade infusions but there are a few things to know before your child starts treatment.

What to expect before pediatric Remicade infusions

Before your child’s first Remicade treatment, we’ll test them for tuberculosis (TB). TB testing is performed by a skin test or blood test. We also recommend that your child’s vaccines be up to date before starting Remicade. Your child should not receive live vaccines while on Remicade.

Since Remicade is an immunosuppressant, children will be less able to fight infections during treatment. For this reason, children shouldn’t receive infusions if they have a cold or flu-like symptoms. They should also avoid contact with family and friends who are sick.

What to expect during pediatric Remicade infusions

Remicade treatments are delivered by intravenous (IV) infusion. On the day of your child’s appointment, we’ll start by prepping your child’s arm by cleaning the area with alcohol. The IV needle will then be inserted into their arm and held in place with medical tape. Once the IV is set up, kids can sit back and relax as they complete their treatment. The IV drip is a portable system, so kids can get up and use the restroom as needed.

Remicade infusions take about 1 – 4 hours, so we encourage kids to come with their iPads, laptops, portable games, books or homework. Our expert team will closely monitor your child and their vital signs throughout their treatment. Parents are also welcome to join their kids during this time.

What to expect after pediatric Remicade infusions

Once your child completes their treatment, we’ll monitor them for a short time (about 30 minutes) to make sure they’re not having a negative reaction to the medication.

After Remicade infusions, kids can feel a bit tired, experience a mild headache or feel other minor side effects. Some kids experience almost an immediate relief in IBD symptoms, which makes them feel happier and more energetic.

Since Remicade doesn’t use any sedation, kids can get back to their usual activities after treatment. Follow-up appointments will also be scheduled to keep track of your child’s progress but if they experience any side effects after their infusion, it’s important to call your child’s doctor.

What questions should I ask my provider about pediatric Remicade infusions?

• Why choose Remicade over other medicine for my child?
• What are the benefits and risks of Remicade?
• What can my child expect with symptom improvement in the short term?
• What can be expected with symptom improvement in the long term?
• How often does my child need to be seen by their gastroenterologist?
• What vaccinations are needed while my child is on Remicade?
• What are some reasons I should call my child’s GI doctor?
• If my child is experiencing symptoms, how can I get in touch with you?