16 May 2018
Celiac disease is an autoimmune condition in which the immune system responds abnormally to gluten, a protein. This occurs as a result of a child’s genetics and exposure to a trigger.
A child who develops celiac disease probably inherits the condition from one or both parents and then develops the disease when exposed to gluten in his/her diet. Exposure to gluten results in inflammation of the small intestine. As a result, people with celiac disease are unable to break down certain foods containing gluten, such as bread, pasta, pizza and cereal. The disease affects both children and adults and occurs in 0.5 to 1 percent of the general population.
What are the symptoms associated with celiac disease?
Classic celiac disease symptoms include those of food malabsorption, such as:
- poor appetite
- difficulty gaining weight
- weight loss
- abdominal pain
- increased gas
- abdominal distention
In addition, some celiac disease patients may have non-gastrointestinal manifestations including short stature, delayed puberty, joint pains, fatigue, brown/yellow teeth with pits or grooves and a rash (dermatitis herpetiformis).
Are certain people considered high-risk for the development of celiac disease?
High-risk individuals include:
- First-generation relatives of patients with celiac disease
- Patients with other autoimmune conditions such as autoimmune thyroiditis, type 1 diabetes and juvenile rheumatoid arthritis
- Patients with Down syndrome, Turner syndrome and Williams syndrome
Who should be screened for celiac disease?
- Patients with associated symptoms
- High-risk patients (regardless of the presence of symptoms)
How are you tested for celiac disease?
Blood work for antibody testing is useful for screening and is usually the first step in the diagnosis of celiac disease. This testing should be performed at a minimum of three years of age and in a patient who is consuming a diet containing gluten for at least one year.
The antibodies measured are:
- 1) tissue transglutaminase
- 2) anti-endomysial antibodies
- 3) the anti-gliadin antibody
Patients with positive antibody testing should undergo an upper endoscopy with intestinal biopsy to confirm the diagnosis of celiac disease.
What is the treatment for celiac disease?
The treatment for this disease is a gluten-free diet, which should be followed for life (not just in childhood).
A person with celiac disease must avoid wheat, barley and rye. Eating even small amounts of gluten can cause intestinal damage and symptoms. Patients and their families are encouraged to meet with a dietitian who is experienced in treating celiac disease patients.
It is important to read the labels on prepared foods and condiments to ensure that there is no exposure to gluten. “Wheat free” does not necessarily mean gluten-free. While oats are naturally gluten free, oats can sometimes be contaminated with wheat during their processing. For this reason, you need to look for packaging that specifically states that the product is gluten-free and was processed in a gluten-free facility.
How are children with celiac disease monitored?
After starting a gluten-free diet, most children begin to feel better in a few weeks. Six months after starting a gluten-free diet, repeat blood testing needs to be done to measure antibody levels, which should be lower than at the time of diagnosis, or normal.
When should I take my child to the doctor?
Your child should be evaluated by a pediatric gastroenterologist if he/she has any of the above-mentioned symptoms or has other family members with the disease. If you think your child has celiac disease, it’s important that he/she sees a doctor before cutting gluten from the diet.
To learn more
- Celiac Support Forum
- Gluten Intolerance Group (GIG)
- Celiac Disease Foundation
- National Celiac Association
- Beyond Celiac
- Gluten Free Help Info
Hill I, et al. Patient education: Celiac disease in children (Beyond the Basics). In: UpToDate. 2017.
If you think your child may have celiac disease, please come see us
If your child is showing signs of celiac disease, please make an appointment with Westchester Health Pediatrics to come in and see one of our pediatricians. We will meet with you and your child, review the symptoms, possibly order some tests, and together with you, decide on the best course of action which may include avoidance of gluten. Whatever the diagnosis, our #1 goal is for your child to get answers and feel better as soon as possible. Whenever, wherever you need us, we’re here for you.