Pediatric celiac disease

What is pediatric celiac disease?

Celiac disease is a serious, lifelong condition that develops when a child’s immune system reacts to gluten, a protein found in foods like wheat, barley and rye. Gluten can also be found in products like make-up, toothpaste, shampoo, medications and even Play-Doh™.

When people have celiac disease, the presence of gluten causes their immune system to create antibodies that attack the inner lining of their small intestine. This damages the small finger-like structures (called villi) that the body needs to absorb nutrients from digested food.

Left untreated, celiac disease can cause serious health issues like delayed puberty, nutritional deficiencies and chronic damage to the small intestine. It can also increase your child’s risk of other autoimmune diseases and even some rare GI cancers.

Though it takes a lot of effort, removing gluten from your child’s diet and environment effectively treats celiac disease. The expert team at Children’s Health is here to hold your hand and help you help your child thrive.

What are the different types of pediatric celiac disease?

Celiac disease is separated into three different types based on the symptoms a child experiences. Maintaining a gluten-free diet and environment is the treatment for all types of celiac disease.

• Classic celiac disease - This is the most common type of celiac disease. Children will often have stomach and other digestive symptoms like diarrhea, steatorrhea (pale, foul-smelling, fatty stools), weight loss and failure to grow.

• Non-classic celiac disease - Children with non-classic celiac disease may have mild gastrointestinal (GI) symptoms, but it is often other health issues that get noticed first. Iron-deficiency anemia, chronic fatigue, migraines, numbness or tingling in the hands or feet, vitamin deficiencies and behavioral issues could be symptoms of non-classic celiac disease.

• Asymptomatic (or silent) celiac disease - Children with silent celiac disease do not show any signs of the disease. It is usually found when children who are at high risk for celiac are screened for the disease.

What are the signs and symptoms of pediatric celiac disease?

• Abdominal pain or bloating

• Anemia

• Diarrhea or constipation

• Delayed puberty or growth

• Inability to eat or failure to thrive (in newborns)

• Fatigue

• Headaches

• Lactose intolerance

• Loss of calcium and bone density

• Damage to dental enamel

• Mouth ulcers

• Irritability

• Pale, foul-smelling stool

• Short height

• Skin rashes

• Weight loss

• Poor weight gain

How is pediatric celiac disease diagnosed?

Celiac disease can develop any time after gluten is introduced into a child’s diet. Your child can be tested for celiac by age two, or even earlier if they show clear signs of the disease.

The diagnosis of celiac disease is difficult because symptoms vary, the test relies on an antibody that is not typically present until the age of two, and children must eat gluten for several months to create an autoimmune reaction.

Early diagnosis of celiac disease is very important to prevent long-term complications.

Diagnosing celiac disease usually starts with two blood tests:

• A serology test looks for increased levels of the antibody proteins that indicate an immune reaction to gluten.

• The second blood test looks for the presence of gene variations that make it possible for someone to develop celiac disease. These gene variations are called HLA-DQ2 and HLA-DQ8). Though everyone who develops celiac has one of these gene variations, not everyone who has these gene variations will develop celiac.

If your child’s results suggest celiac disease your doctor may schedule:

• Minimally invasive endoscopy procedures to examine your child’s stomach and small intestine. These procedures look to see if there is inflammation and damage to the tissue and villi

• A biopsy, in which a tiny piece of the inside layer of your child’s small intestine is removed so your doctor can look at it under a microscope to check for signs of inflammation and disease

What causes pediatric celiac disease?

Though the exact cause is not known, researchers believe it is a combination of genetics, gluten-rich foods, and things in the environment that affect health (like air pollution or exposure to chemicals).

Other possible causes can include:

• An imbalance of the bacteria and other organisms in the stomach

• Emotional or psychological stress

• Gastrointestinal infections

• Viral infections

Celiac disease is one of the most common genetic diseases and affects almost 1% of the population. It can develop at any point in a person’s life. Children who have family members with the disease are more likely to develop it.

How is pediatric celiac disease treated?

Removing all foods and products containing gluten from your child’s environment is the only effective treatment for celiac disease. We know that maintaining a gluten-free diet and environment can seem overwhelming for you and your family. Our warm, caring celiac disease experts are dedicated to helping you and your child make it work.

Our dietitian will help you create a gluten-free diet and environment. Our social worker can work with you and your child’s school to set up any accommodations they may need. And each year, your child’s doctor will check to see if their disease is active and make sure they are getting the nutrients they need to grow and thrive.

Our team also organizes activities to help your family safely celebrate life’s milestones and create community with other families living with celiac. We’ll even connect you to gluten-free summer camps where children can enjoy a typical summer experience while learning to care for themselves.

The team at Children’s Health is committed to making living gluten-free easier and are here to guide and coach you along the way.