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Celiac Disease

Pediatric Basics

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Updated April 24, 2008

Celiac disease is an autoimmune disorder, with symptoms that range from gas and diarrhea to irritability and depression. It is caused by an intolerance to the protein gluten, which is found in foods that contain wheat, rye, and barley.

Symptoms of Celiac Disease

Children can develop symptoms of celiac disease once gluten has been introduced into their diet, and is usually sometime between 6 months and 2 years of age, although the symptoms may not be formally diagnosed as being caused by celiac disease until they are much older.

Symptoms of celiac disease can include:

  • delayed growth and failure to thrive
  • chronic diarrhea
  • behavioral changes, including irritability
  • recurrent gas, abdominal bloating, and pain
  • pale, foul-smelling, or fatty stools
  • constipation
  • fatigue
  • unexplained iron deficiency anemia (a low red blood cell count)
  • delayed puberty
These symptoms do vary though, and some people with celiac disease have no symptoms at all, infants with classic celiac disease are often described as 'clingy, irritable, unhappy children who are difficult to comfort.'

Diagnosis of Celiac Disease

Although some people simply try and see if their child will improve on a gluten-free diet to see if their child has celiac disease, since this is a lifelong condition, formal diagnosis and testing is usually a good idea.

Testing for celiac disease can include screening blood tests, such as:

  • Immunoglobulin A (IgA)
  • anti-tissue transglutaminase (tTGA)
  • IgA anti-endomysium antibodies (AEA)
If these screening tests are suspicious for celiac disease, a small bowel biopsy will usually be done by a pediatric gastroenterologist to confirm the diagnosis.

Treatments for Celiac Disease

There is no cure or medication to treat celiac disease. Instead, parents must put their children on a gluten-free diet that doesn't contain any foods that are made with wheat, rye, or barley.

To help avoid gluten, including many grains, pasta, cereals, and other processed foods with gluten, it can help to learn to read food labels and look for and avoid products with the following ingredients on the label:

  • wheat, including durum, graham, kamut, semolina, spelt, triticale
  • barley, including malt, malt vinegar, or malt flavoring which can be made from barley
  • rye
Gluten can also be found in some candy, cold cuts, soy sauce, vitamins, herbal supplements, over the counter medications, and prescription medications. And although often overlooked, gluten is also found in communion wafers, lip balms, and Play Doh.

Fortunately, there are many gluten-free breads and pastas and even gluten-free medications for children on a gluten-free diet.

Still, it can be hard to follow a gluten-free diet, so you may seek help from a registered dietician to make sure that your child still eats well balanced meals, while keeping gluten out of his diet.

What You Need To Know About Celiac Disease

  • Infants are often first introduced to gluten when they 'graduate' from rice cereal and start a single grain cereal with barley or Cheerios, etc.

  • Many experts also recommend that a child on a gluten-free diet also avoid oats, although this is controversial and is still being researched. The Celiac Sprue Association, a nonprofit support group, states that 'pure oats may be included as part of a gluten-free diet,' but then goes on to suggest that people on a gluten-free diet avoid oats anyway because 'uncontaminated oat sources are not readily available.'

  • Celiac disease is genetic and so can run in certain families, especially if they are descendants of people from northern Europe.

  • Many experts think that celiac disease is underdiagnosed in the United States.

  • Celiac disease is also known as celiac sprue, gluten-sensitive enteropathy, and non-tropical sprue.

  • Children don't outgrow celiac disease and so must continue the gluten-free diet their whole life.

  • A pediatric gastroenterologist can help diagnose and treat your child with celiac disease.



Sources:

National Digestive Diseases Information Clearinghouse. NIH Publication No. 07–4269. Celiac Disease.

Behrman: Nelson Textbook of Pediatrics, 17th ed.

AHRQ Releases Practice Guidelines for Celiac Disease Screening. HELLEKSON K - Am Fam Physician - May 1, 2005; 71(9); 1814-1819.

Celiac disease. Rossi T - Adolesc Med Clin - 01-FEB-2004; 15(1): 91-103.

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