Celiac Disease in Children

Celiac disease can develop in children any time after gluten containing foods (such as wheat)  are introduced into the diet, usually 6-9 months of age. Celiac disease is an autoimmune condition that damages the lining of the small intestine resulting in gastrointestinal issues. Other symptoms such as itchy skin rashes are also associated with celiac disease in children. The only current treatment for celiac disease is a 100% gluten-free diet. 

How celiac disease affects children according to age

According to the Celiac Disease Foundation, celiac disease affects children in different ways according to age. Infants and toddlers tend to have more obvious gastrointestinal symptoms such as vomiting and diarrhea. School-aged children have less obvious gastrointestinal symptoms than infants and toddlers, but symptoms still occur such as constipation and issues with weight loss and weight gain. Other children and teens have the least evident symptoms compared to younger children, but do have more symptoms or signs that are not obviously related to the intestinal tract such as delayed puberty, bone and joint pain, and chronic fatigue. 

Celiac disease symptoms in children include but are not limited to:

• Vomiting
• Bloating
• Irritability
• Abdominal distention
• Diarrhea
• Constipation
• Malnutrition
• Stomach aches or abdominal pain 
• Stunted growth
• Weight gain
• Weight loss
• Delayed puberty
• Chronic fatigue
• Joint or bone pain
• Recurring headaches or migraines
• Itchy skin rash 
• Recurring mouth sores
• Anxiety
• Depression
• Panic attacks 

Severe celiac disease symptoms in children are rare but can include:

• Extremely low blood pressure
• Excessive water loss in stool 
• Abdominal obstruction 

Celiac disease is genetic

First-degree relatives (parent, sibling, child) of an individual with celiac disease have approximately 5%-20% risk of developing celiac disease compared to 1% risk for the general population. Children who are diagnosed with celiac disease have inherited one or both of their parents’ celiac risk genes known as the HLA-DQ2 and/or HLA-DQ8 (DQ2/DQ8) celiac risk alleles. Though a child can inherit celiac risk alleles from their parents, this does not mean that they will develop celiac disease in their lifetime. At least 3 factors must be present for the definitive development and diagnosis of celiac disease: 1) Gluten – gluten must be ingested for the immune reaction to occur 2) Gene – the child must carry at least one of 2 HLA alleles associated with celiac disease and 3) Trigger – something must activate celiac disease such as environmental factors, stress or other underlying health issues. 

Diagnosis of celiac risk 

The simplest and most efficient way to see if a child has inherited their parents’ celiac risk alleles is through a genetic test like the GlutenID^® test. Genetic testing can determine whether or not an at-risk individual or in this case, child, carries the genes necessary for the development of celiac disease. A genetic test is not used for a definitive diagnosis of celiac disease, but rather to “rule out” the disease which would indicate that the child did not inherit celiac risk genes from their parent(s). If the genetic test is negative, it will not be required for the child to have a blood screening or an endoscopic biopsy for diagnosis of celiac disease. If results are positive for one or both celiac risk genes, parents will know which children need close monitoring for symptoms when gluten is ingested by the child. 

It is possible that a child did not inherit either for the HLA alleles associated with celiac disease, but still has symptoms similar to the autoimmune disorder. In this case, the child would most likely have Non-Celiac Gluten Sensitivity (gluten sensitivity or gluten intolerance) and would still need to be on a 100% gluten-free diet. 

Treatment for celiac disease

After a child has been diagnosed with celiac disease through an endoscopic biopsy, they’ll need to follow a strict, gluten-free diet. It is recommended to always talk to a doctor before completely cutting out gluten from your child’s diet. Eating a gluten-free diet is the only way kids with celiac will maintain a healthy lifestyle. There is currently no medicine or treatment that can make the disease completely go away. For a guide to getting started on a gluten-free diet, please click here.