Food is a non-negotiable, vital part of life - especially in babies, toddlers, and children who need nourishment to grow and thrive.
For kids and people with celiac disease, though, certain types of food - specifically gluten-containing foods - can actually be harmful. So much to the point growth can be stunted, quality of life can be compromised, amongst other physical, mental, and emotional health risks.
Fortunately, celiac disease in children and adults alike can be fully managed. A proper diagnosis spurred by recognizing signs and symptoms is the essential step for getting life and health back on track.
Understanding Celiac in Toddlers & Children
Celiac disease is an autoimmune disease in which the body's own immune system perceives gluten as a harmful and toxic substance. Gluten is the protein found in wheat, rye, barley, and oftentimes oats.
Following gluten intake, the body essentially attacks itself and cascades an undesirable reaction. More specifically, the villi in the small intestine are damaged. Villi are finger-like projections that essentially grip and absorb nutrients from foods. Damage to the villi causes unpleasant digestive symptoms and can lead to long-term health risks, especially if the damage is prolonged.
Celiac disease can occur at any age but is suggested to have two peaks:
1. After gluten intake within the first 2 years of life
2. Often seen in the second or third decade of life
Interestingly, celiac disease is approximately two times higher in children than adults. The disparity is thought to be caused by a variety of factors, including those detailed right below.
Causes of Celiac Disease in Children
As mentioned, celiac disease is an autoimmune disease. The exact cause is not well understood, though it is essentially the perfect storm of genetics, environmental factors, and other elements.
Research also suggests breast milk, mode of delivery, and the age of gluten intake in infants might be risk factors. Gastrointestinal system (GIS) infections - like rotavirus - may increase the risk of developing celiac disease as well.
Other risk factors for developing celiac disease include a family history of celiac disease, especially first- and second-degree relatives. Certain conditions can also increase risk, including:
• Down syndrome
• Type 1 diabetes
• Selective immunoglobulin (Ig) A deficiency
• Autoimmune thyroiditis
• Turner syndrome
• Williams syndrome
Understanding risk factors can be helpful to pinpoint and test for celiac disease, especially when symptoms are not so clear.
Celiac Disease Symptoms in Children
Celiac disease symptoms in children may first show following the introduction of solid foods including gluten-containing cereals. There can also be a delayed period between gluten intake and symptom onset.
Despite the overlapping signs and symptoms of celiac disease in children and adults, they tend to be more pronounced during childhood. Common celiac disease symptoms in children mostly relate to the gastrointestinal tract such as:
• Chronic diarrhea
• Abdominal pain and distention
Especially if the diagnosis is delayed in early childhood, and while age-dependent, a child might also experience severe health risks such as:
• Dermatitis herpetiformitis
• Poor appetite
• Failure to thrive
• Weight loss
• Muscle wasting
• Short stature
• Severe malnutrition
• Osteopenia and osteoporosis
• Chronic fatigue
Although mostly occurring in teenagers and adults, this blistering skin rash may also be witnessed in children. It is commonly noticed on the elbows, knees, and buttocks regions.
If celiac disease goes untreated, children with celiac may experience short stature and impaired growth hormones. Additionally, adolescent girls have been shown to have delayed or absent menstrual cycles.
Compromised Bone Development
Children may experience bone loss, severely affecting the critical development of the skeletal system. Managing celiac disease has been shown to positively impact and restore bone density.
Arthritis is commonly witnessed and developed in adulthood. However, a small portion of children may experience arthritic symptoms or become diagnosed with juvenile chronic arthritis.
Speculations have suggested gluten contributed to a large number of behavioral problems, including autism and attention deficit hyperactivity disorder (ADHD). Though no sound evidence has concluded such links, celiac disease has been linked to depression and anxiety.
How to Diagnose & Manage Celiac Disease in Children
Since celiac disease symptoms in children vary from one child to the next, diagnosing the condition can be challenging. Fortunately, though, various tests can help diagnose celiac disease properly so management can ensue.
Diagnosing Celiac Disease
If suspecting an adverse reaction to gluten or noticing shortcomings in overall development, seek out professional guidance right away. This is because the quicker the diagnosis and management, the sooner kids can catch up on growth and other vital milestones.
At the consultation, make sure to inform the physician of any symptoms and provide a full family history. A series of serological tests will be conducted and potentially a recommended biopsy.
If the child tests negatively for celiac disease, he or she may be suffering from a gluten sensitivity or wheat allergy. Being diligent on a healthful diet and seeking out further healthcare can be extremely valuable to reduce unpleasant symptoms and complications.
Managing Celiac Disease
If diagnosed with celiac disease, a gluten-free diet will be recommended. A gluten-free diet is the only known treatment of celiac disease at this time, so eliminating gluten-containing food products is imperative.
Working with a dietitian is recommended when navigating a gluten-free diet, especially in a healthy manner to promote child development. Also, continue working with a doctor and other healthcare members to ensure celiac disease is managed properly.
Recapping Celiac Disease in Children
Celiac disease is an autoimmune condition that can occur at any age. Recognizing celiac disease symptoms in children is key for paving the way to a proper diagnosis.
While there is no cure for celiac disease, it can be effectively managed. Long-term compliance to a gluten-free diet can lead to better health outcomes and improve quality of life.
Guandalini S. Pediatric Celiac Disease Clinical Presentation. Medscape. Available at: http://emedicine.medscape.com/article/932104-clinical.
Sahin Y. Celiac disease in children: A review of the literature. World J Clin Pediatr. 2021;10(4):53-71. Published 2021 Jul 9. doi:10.5409/wjcp.v10.i4.53.