Biologics and infusion treatments for children

Biologic medications are an important treatment option for children living with Crohn’s disease and ulcerative colitis (IBD). If your child’s current medication is not controlling their symptoms, or their disease is more severe, their paediatric gastroenterologist may recommend a biologic treatment.

Starting a new medication can feel overwhelming for families. Understanding how biologics work, how treatments are given, and what to expect can help you and your child feel more prepared.

💊 What Are Biologics?

Biologics are medicines made from living organisms that target specific parts of the immune system involved in inflammation. Unlike some traditional IBD medications, which affect the immune system more broadly, biologics target particular proteins or pathways that contribute to inflammation in the digestive tract.

They can help reduce inflammation, improve symptoms, support healing of the bowel lining, and maintain remission.

Biologics may be recommended when:

• Other medications have not controlled your child’s IBD.

• Your child has moderate to severe Crohn’s disease or ulcerative colitis.

• Your child has complications or a higher risk of disease progression.

• Their gastroenterologist believes early biologic treatment may offer better disease control.

Biologics do not cure IBD, but they can help many children achieve and maintain remission.

🧬 Which biologics are used for children in the USA?

Several biologic medications are used to treat paediatric IBD in the United States. The most appropriate option depends on your child’s diagnosis, age, disease severity, medical history, and previous treatments.

Common biologic options include:

• Infliximab (Remicade and biosimilars): An anti-TNF medication commonly used for paediatric Crohn’s disease and ulcerative colitis. It is given through an intravenous (IV) infusion.

• Adalimumab (Humira and biosimilars): Another anti-TNF medication that is given as an injection under the skin. Some families learn to administer it at home.

• Ustekinumab (Stelara and biosimilars, where applicable): Targets interleukin-12 and interleukin-23, proteins involved in inflammation. Treatment generally begins with an IV infusion, followed by injections under the skin.

• Vedolizumab (Entyvio): Targets immune-cell movement into the gut and is used for Crohn’s disease and ulcerative colitis. It can be given by IV infusion, with subcutaneous options available for eligible patients.

Other targeted treatments may be considered depending on your child’s age, diagnosis, and treatment history. Not every medication is approved for every age group or indication, and approval and insurance coverage can vary. Your child’s gastroenterologist can explain which options are appropriate.

💉 What is an infusion treatment?

An infusion delivers medication directly into a vein through an IV line. In paediatric IBD, infliximab is a commonly used infusion treatment.

Infusions are usually given at a hospital, specialist infusion centre, or another approved healthcare facility. Your child will be monitored during treatment for possible reactions.

A typical appointment may include:

• Checking your child’s weight, temperature, and other vital signs.

• Placing an IV line in a vein, usually in the arm or hand.

• Administering the medication over a period of time.

• Monitoring your child during and sometimes after the infusion.

The first appointment may take several hours, depending on the medication, preparation, and monitoring requirements. Subsequent appointments may be shorter.

🗓️ How often will my child need infusions?

The schedule depends on the medication and your child’s individual treatment plan.

For infliximab, treatment commonly begins with three induction infusions at weeks 0, 2, and 6, followed by maintenance infusions approximately every 8 weeks. Some children need more frequent infusions or dose adjustments to control their disease.

The gastroenterology team may use blood tests, stool tests such as faecal calprotectin, symptom reviews, and drug-level testing to assess how well treatment is working.

Your child’s schedule may change over time based on their response to treatment.

🏥 Where can children receive infusions in the USA?

Children may receive biologic infusions at:

• Children’s hospitals with paediatric gastroenterology services.

• Hospital-based infusion centres.

• Specialist outpatient infusion centres that treat children.

• Other facilities approved by the prescribing team and insurance provider.

Your child’s gastroenterologist can help arrange an appropriate location. Some families travel to a specialist children’s hospital, while others can receive ongoing treatment closer to home.

When choosing an infusion centre, ask whether staff have experience treating children with IBD and whether they can manage infusion reactions if they occur.

🧸 What happens during an infusion appointment?

Infusions can feel intimidating, particularly for younger children or children who are anxious about needles.

You can help your child prepare by explaining what will happen in simple, reassuring language. Let them know they can bring comfort items, headphones, books, games, or a favourite blanket if the centre allows them.

Helpful strategies include:

• Bringing snacks and drinks, if permitted.

• Planning a quiet activity for the appointment.

• Asking about numbing cream or other ways to make IV placement more comfortable.

• Checking whether a parent or caregiver can remain with the child throughout treatment.

• Asking the infusion team about child-life specialists or other support for children who are nervous.

It may help to describe the appointment as a way of giving their body medicine to help calm the inflammation, rather than focusing on the needle.

⚠️ What are the possible side effects?

Biologics can be very effective, but they can also have side effects. The risks depend on the medication and your child’s health.

Possible side effects include:

• Headaches, nausea, or fatigue.

• Infusion reactions, such as itching, flushing, rash, dizziness, or breathing difficulties.

• An increased risk of certain infections because the medication affects immune function.

• Injection-site reactions with medicines given under the skin.

Rarely, more serious reactions or complications can occur.

Before starting treatment, the medical team usually screens for infections such as tuberculosis and hepatitis B, reviews vaccination history, and arranges appropriate blood tests.

Contact your child’s healthcare team if they develop a fever or signs of infection. Seek urgent medical care for severe breathing difficulties, facial or throat swelling, or other signs of a serious allergic reaction.

🛡️ Can my child attend school and play sport?

Many children receiving biologics can continue attending school, playing sport, seeing friends, and participating in everyday activities.

Treatment is intended to control inflammation and help children feel well enough to enjoy normal childhood experiences.

However, biologics can increase the risk of some infections. Your child’s healthcare team can advise on precautions based on their medication and health.

It is also important to:

• Ask before giving any live vaccine, as some may be unsuitable during biologic treatment.

• Encourage good handwashing and sensible infection precautions.

• Let the medical team know if your child has a significant infection or is due for surgery.

If your child feels tired after an infusion, they may need some downtime. Otherwise, activities can usually continue as tolerated.

💰 How much do biologics cost in the USA?

The cost of biologic treatment in the United States varies considerably depending on the medication, insurance plan, treatment setting, and whether a brand-name medicine or biosimilar is used.

Health insurance may cover biologics when they are medically necessary, but families can still face deductibles, copayments, coinsurance, and other out-of-pocket expenses.

Before treatment begins, contact your insurance provider and ask:

• Is the medication covered under my child’s plan?

• Does it require prior authorisation?

• Must treatment be given at a particular infusion centre?

• What will we pay for each infusion or injection?

• Is there a preferred biosimilar?

• Are there financial assistance or copay support programmes available?

The hospital’s financial counsellor, insurance coordinator, or the medication manufacturer’s patient support programme may be able to help you understand your options.

❤️ What if the first biologic does not work?

Not every child responds to their first biologic, and some children initially improve but later experience a loss of response.

If this happens, the gastroenterologist may assess whether:

• The dose or frequency needs adjusting.

• The body has developed antibodies against the medication.

• The medication is reaching an effective level in the bloodstream.

• A different biologic or treatment approach would be more appropriate.

Changing treatment does not mean your child has run out of options. There are several therapies available, and the goal is to find the approach that controls inflammation while supporting your child’s growth, development, and quality of life.

📝 Questions to ask your child’s gastroenterologist

Before starting a biologic, consider asking:

• Why are you recommending this medication for my child?

• What benefits should we expect, and how will we measure success?

• How is it given, and how often will treatment be needed?

• What side effects should we look out for?

• Which vaccinations or infection precautions are important?

• What happens if my child develops a fever or becomes unwell before an infusion?

• How will treatment affect school, sport, travel, and daily activities?

• What will our insurance cover, and what costs should we expect?

• What is the plan if the medication does not work?

You do not need to remember every question at once. Taking a written list to appointments can help you feel more confident and ensure your concerns are addressed.

🌟 Helping your child feel supported

Starting a biologic can be a big step for a child and their family. It is normal to have questions about safety, needles, side effects, and what treatment means for the future.

Give your child opportunities to ask questions and express their feelings. Older children and teenagers may also want to understand their medication and take a more active role in their care.

With the right medical support, biologic treatment can help many children with IBD manage inflammation and get back to the activities and experiences that matter to them.

Remember: Every child’s IBD is different. Treatment decisions should always be made with your child’s paediatric gastroenterologist, who can explain the benefits, risks, and available options for your child.

🔗 Helpful resources in the USA

• Crohn’s & Colitis Foundation — Information about IBD, treatments, support programmes, and living with Crohn’s disease or ulcerative colitis.

• US Food and Drug Administration (FDA) — Official information about medication approvals, safety updates, and prescribing information.

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — Information about Crohn’s disease, ulcerative colitis, and digestive health.

This article is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your child’s paediatric gastroenterologist before making decisions about medications or treatment. Treatment options, approvals, and insurance coverage may vary in the USA.