Celiac disease is a severe genetic autoimmune disease that affects adults and children of all races and genders. Celiac disease in kids can negatively impact optimal growth and development. About one in 100 people has celiac disease, making it one of the most common conditions in children.
Kids with celiac disease are permanently intolerant to gluten, a protein found in all forms of wheat, rye, and barley. A common belief is that gluten is found only in foods. Many everyday products, including medications, vitamins, and cosmetic products such as lotion, shampoo, toothpaste, etc., uses this protein.
What is Celiac Disease?
Celiac disease is an autoimmune digestive disease that damages the small intestine and interferes with the absorption of nutrients from food. It is also known as celiac sprue or gluten-sensitive enteropathy.
When kids with celiac disease eat foods with gluten, their immune system starts to attack the villi – tiny, finger-like projections on the internal lining of the small intestine. They help your body to absorb nutrients from food into your bloodstream. Without the villi, your small intestine can’t get enough vitamins and nutrients your kids need to grow strong and healthy, no matter how much food they eat.
Celiac disease in kids can result in malnutrition, gastrointestinal symptoms, and poor weight gain. Children with celiac disease may not get adequate nutrition even if they consume
Causes of Celiac Disease in Children
Celiac disease is a genetically inherited disorder caused by an abnormal immune system response to gluten, a protein found in barley, wheat, and rye. It leads to an immune-mediated inflammation of the small intestine. The problematic HLA DQ protein-coding gene located on chromosome number six causes this gluten sensitivity. This gene can be inherited (hereditary), which means the condition can run in families.
If a family member has celiac disease, your child is more likely to inherit this gene. However, many people with this gene never develop the disease. Therefore, the exact cause of the celiac disease is unknown.
Celiac disease may be triggered in some individuals by a combination of
- Having the genes that increase susceptibility to celiac disease
- Exposure to gluten
- Exposure to certain toxins
- Infections (such as rotavirus)
The following conditions may put a child at a higher risk of developing the celiac disease:
- Siblings or other immediate relatives with celiac disease
- Down syndrome
- Type 1 diabetes
- Selective IgA deficiency
- Turner syndrome
- Williams syndrome
- Autoimmune thyroiditis
Symptoms of Celiac Disease in Kids
Most kids are diagnosed with celiac disease when they’re between 6 months and two years old, which is when most kids get their first taste of gluten in foods. Some kids become ill early in life, and others fall ill only after years of exposure; it is unknown why.
There is wide variation in the severity of symptoms – many children will experience symptoms within minutes to hours after consuming gluten, which may only last a few hours. In others, symptoms may last several days or up to two weeks.
Many children have mild symptoms that are easy to miss, such as having excessive gas, abdominal pain, or constipation. Other children have more severe symptoms resulting in an earlier diagnosis, including failure to thrive, weight loss, and vomiting.
Celiac disease affects children in different ways, depending on their age. They are:
Infants and Toddlers Infants and toddlers tend to have more apparent symptoms, usually manifest in the gastrointestinal tract. Symptoms include, but are not limited to:
- Poor growth
- Abdominal distention
- Diarrhea with very foul stools
- School-Age Children
Vomiting is less common in school-age children than in infants and toddlers. Symptoms include, but are not limited to:
- Stomach aches or abdominal pain
- Abdominal distention
- Trouble gaining weight or weight loss
- Older Children and Teens
Older children and teenagers may have symptoms or concerning signs unrelated to the intestinal tract, which are called “extra-intestinal” or “atypical” symptoms.
These symptoms are what may convince a physician to test for celiac disease. Some of these manifestations include:
- Stunted growth
- Weight loss
- Delayed puberty
- Achy pain in the bones or joints
- Chronic fatigue
- Recurrent headaches or migraines
- Itchy skin rash (dermatitis herpetiformis)
- Recurring mouth sores called aphthous ulcers, which look like canker sores
Adolescents with celiac disease may also have mood disorders, including anxiety and depression, and panic attacks.
Types of Celiac Disease in Kids
There are four types of celiac disease, and they are as follows:
- Classic Celiac Disease
It is the most commonly described form and produces all of the symptoms associated with gluten intolerance and evident signs of malabsorption, such as:
- Steatorrhea (pale, pungent, fatty stools)
- Reduced appetite
- Weight loss or poor weight gain
- Short stature
- Mouth ulcers
- Failure of growth in children
- Atypical Celiac Disease
It is also one of the most common forms. It produces mild gastrointestinal symptoms (which means they develop symptoms beyond their gut) without evident signs of malabsorption, such as:
- Abdominal pain
- Anemia or Iron-deficiency
- Severe migraine
- Peripheral neuropathy (tingly, numb, or aching hands and feet)
- Elevated liver enzymes or hepatitis
- Reduced bone density (osteopenia and osteoporosis)
- Folic acid deficiency
- Vitamin B12 deficiency
- Difficulty in losing weight
- Delayed puberty
- Unexplained infertility
- Defects of the dental enamel
- Behavioral problems
- Skin rashes
- Silent Celiac Disease
It is an asymptomatic form of celiac disease, and patients do not exhibit or report any problems. Still, they test positive for it with damaged villi in the small intestines. Patients may not have any significant symptoms, but they may report better health once they switch to a gluten-free diet. They experience reduced acid reflux, flatulence, and abdominal bloating and distension.
- Latent Celiac Disease
It is an asymptomatic form of celiac disease. Patients with latent celiac disease test negative for it but eventually test positive as they develop it.
Gluten intolerance can cause this itchy, blistering skin disease. The rash usually occurs on the elbows, knees, torso, scalp, and buttocks. This condition is often associated with changes to the small intestine lining identical to those of celiac disease. Still, the skin condition might not cause digestive symptoms. Doctors treat dermatitis herpetiformis with a gluten-free diet or medication, or both, to control the rash.
Diagnosis of Celiac Disease in Kids
Celiac disease is chronic, which means it is a lifelong condition. It is essential to test your child at the first signs or if the celiac disease runs in your family. First-degree relatives (parent, sibling, child) have a 1 in 10 chance of developing the celiac disease themselves.
If you think your child could have celiac disease or show the signs and symptoms of celiac disease or if there is a positive family history, then you should consult a doctor for your child. Your doctor may order the following tests:
1. Serology or Blood test: The blood tests look for antibodies against gluten produced during an immune reaction.
2. Genetic test: Genetic test helps identify defective genes that point towards celiac disease. If the serologic and genetic tests are positive, your teen may undergo the following tests to visualize the intestines.
3. Endoscopy: If the serology tests are positive, the doctors will perform an upper gastrointestinal endoscopy. In this short procedure, a tiny flexible tube with a camera is passed through the child’s throat and guided into the small intestine. The doctor looks for signs of damaged chorionic villi.
4. Biopsy: The doctor might collect a small tissue sample during endoscopy and send it for biopsy. The presence of damaged and inflamed tissue will confirm the celiac disease in the child. Also, skin tissue is collected for skin biopsy if dermatitis herpetiformis presents itself.
Treating Celiac Disease in Kids
The only treatment for celiac disease is a lifelong gluten-free diet, eliminating all forms of wheat, rye, and barley. Eating gluten will do more damage to your small intestine.
For some patients with celiac disease, starting a gluten-free diet can improve symptoms in as little as two weeks. Your small intestine should heal completely in 3 to 6 months. Your villi will be back and working again. If you are older, it may take up to 2 years for your body to heal. In most cases, taking gluten out of your diet will stop your symptoms, and any damage to your intestine will heal and stop more damage from happening.
At first, the gluten-free diet can be difficult because gluten is usually a “hidden” ingredient in many processed foods, condiments, salad dressings, etc. For this reason, your healthcare provider may refer you to a dietitian who specializes in celiac disease.
Also, recent labeling laws have made it easier to read the labels of food items containing wheat. However, food items containing malt or barley and their derivatives are not covered under those laws, so it is essential to read food labels carefully to avoid gluten.
Depending on the child’s age, peer pressure can lead to “cheating,” so working with a healthcare professional to ensure success is crucial. Supportive counseling can help to create proper motivation for parents and children.
Foods And Ingredients To Avoid for Kids with Celiac Disease
The treatment for celiac disease is nutritional and requires the removal of gluten – a protein found in wheat, rye, and barley – from the diet. It is essential to check with a healthcare provider before implementing a child’s diet changes. Your child needs to consume an entirely gluten-free diet for their entire life.
The gluten-containing foods to avoid are as follows:
- Breakfast cereals
- Pizza base
- Crumbed or battered food
The following ingredients or products may contain gluten and often go unnoticed:
- Food preservatives
- Food stabilizers
- Modified food starch
- Malt vinegar
- Soy sauce
- Salad dressings
- Prescription and OTC medicines
- Makeup products such as lip balms, lip colors, and lip gloss
Gluten-Free Foods for Kids with Celiac Disease
The following food items, among various others, can be included in the diet:
- Fresh meat and poultry
- Dairy products
- Corn and cornmeal
- Gram flour
Complications Of Celiac Disease in Kids
The following complications may occur if the celiac disease in kids is left untreated:
Malnutrition: This occurs if your small intestine can’t absorb enough nutrients. Malnutrition can lead to weight loss, growth delay, and anemia in children.
Bone weakening: Long-term malabsorption of calcium and vitamin D can lead to softening of the bones (osteomalacia or rickets) in children. It can also lead to a loss of bone density (osteopenia or osteoporosis) in adults.
Infertility and miscarriage: Malabsorption of calcium and vitamin D can contribute to reproductive issues in the future.
Lactose Intolerance: Intestinal wall damage may cause lactose intolerance, resulting in abdominal pain, gas, and diarrhea during the consumption of dairy products.
Cancer: People with celiac disease who don’t maintain a gluten-free diet have a greater risk of developing cancer, including intestinal lymphoma and small bowel cancer.
Nervous system problems: Some people with celiac disease can develop problems such as seizures or a condition of the nerves in the hands and feet (peripheral neuropathy).
Celiac disease is one of the most common genetic conditions globally, affecting 1 in every 133 people of all races, ages, and genders. There are 3 million people in the United States who have celiac disease. Celiac disease is not an allergy, but it is an autoimmune disorder. Undiagnosed and untreated celiac disease in kids may result in several nutritional deficiencies.
Remember, celiac disease can develop at any age, so it’s crucial to monitor your child’s body’s response to gluten. Individuals cannot grow out of celiac disease, and the only treatment for celiac disease is a 100% gluten-free diet, which must be followed for life. It is best to transition your child to a gluten-free diet as soon as possible. The sooner your child is gluten-free, the sooner they stop suffering and start healing.
Do not worry!
Even if your child has celiac disease, they can still have a balanced, nutritious, and interesting diet. Most supermarkets carry a selection of gluten-free foods. It’s good to talk with a dietitian about managing your child’s diet. The dietitian can also recommend reliable recipes, cookbooks, and websites.
Aside from a few dietary changes, avoiding gluten-rich foods, and taking certain medications, children with celiac disease can enjoy a normal, healthy life. As a parent, it’s essential to foster a positive outlook in your child. Celiac disease may define what they eat, but it doesn’t have to define how they live!
Read more about Celiac Disease here!