Celiac disease may develop any time after wheat or other gluten containing foods are introduced into the diet, typically after 6-9 months of age. It is unknown why some children become ill early in life and others fall ill only after years of exposure. It is very important to test your child at the very first signs, or if celiac disease runs in your family. First-degree relatives (parent, sibling, child) have a 1 in 10 chance of developing celiac disease themselves.
Edward Joel Hoffenberg, MD, Celiac Disease Foundation Medical Advisory Board Member and Medical Director of the Program for Pediatric Inflammatory Bowel Diseases at Children’s Hospital Colorado, discusses celiac disease in children and adolescents
Celiac disease may develop any time after wheat or other gluten containing foods are introduced into the diet, typically after 6-9 months of age. It is unknown why some children become ill early in life and others fall ill only after years of exposure. 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 that can result in an earlier diagnosis, including failure to thrive, weight loss, and vomiting. Fortunately, children and adolescents typically respond well to treatment with the gluten-free diet. Most children feel significantly better after two weeks on the diet and attain normal height, weight, and bone health.
Celiac disease affects children in different ways, depending on their age
Infants and Toddlers
Infants and toddlers tend to have more obvious symptoms which usually manifest in the gastrointestinal tract. Symptoms include, but are not limited to:
- Poor growth
- Abdominal distention
- Diarrhea with very foul stools
Infants and toddlers can suffer from malnutrition, leading to poor growth in weight and/or height.
Screening for Celiac Disease in Children Under the Age of 3
From the University of Chicago Celiac Disease Center: “Generally, children at risk for celiac disease are screened at age 2 or 3 unless symptoms are seen beforehand. In children younger than 3, with symptoms, antibody testing may not always be accurate. Children must be eating wheat or barley-based cereals for some time, up to one year, before they can generate an autoimmune response to gluten that shows up in testing. A pediatric gastroenterologist should evaluate young children experiencing a failure to thrive or persistent diarrhea for celiac disease. While a genetic test cannot diagnose celiac disease by itself, it can all but rule it out if neither of the genes are present, and a genetic test can be done at any age.”
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 that are not obviously related 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, as well as panic attacks.
Celiac Disease in Children with No or Mild Symptoms
There are two primary ways that celiac disease can be found in children without symptoms of concern. The first is to have an associated condition in which testing for celiac disease is recommended:
- Family member with celiac disease
- Type 1 diabetes
- Thyroid disease
- IgA deficiency
- Juvenile Chronic Arthritis
- Down syndrome (Trisomy 21)
- Williams syndrome
- Turner syndrome
The second is to have other signs of celiac disease that do not cause typical symptoms:
- Iron deficiency anemia
- High levels of liver enzymes AST and ALT
- Osteopenia (thin bones)
- Dental enamel defects
Severe Celiac Disease in Children
Severe cases of celiac disease in childhood are now very rare. Symptoms of severe cases include:
- Chronic fatigue
- Very low blood pressure
- Excessive water loss in stool, leading to “electrolyte disturbance”
- Abdominal obstruction called “intussusception”
Family Members and Risk
It is very important to test your child for celiac disease at the very first signs, or if celiac disease runs in your family. First-degree relatives (parent, sibling, child) of someone with celiac disease have a 1 in 10 chance of developing celiac disease themselves.
Screening and Diagnosis
A simple blood test is available to screen for celiac disease. People with celiac disease who eat gluten have higher than normal levels of certain antibodies in their blood. These antibodies are produced by the immune system because it views gluten (the proteins found in wheat, rye and barley) as a threat. You must be on a gluten-containing diet for antibody (blood) testing to be accurate.
The only way to confirm a celiac disease diagnosis is by undergoing an endoscopic biopsy of the small intestine.
Non-Celiac Wheat Sensitivity
Some people experience symptoms found in celiac disease, such as “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, yet do not test positive for celiac disease. The terms non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) are generally used to refer to this condition, when removing gluten from the diet resolves symptoms.
Currently, the only treatment for celiac disease and non-celiac wheat sensitivity is lifelong adherence to a strict gluten-free diet. People living gluten-free must avoid foods with wheat, rye and barley, such as bread and beer. Ingesting small amounts of gluten, like crumbs from a cutting board or toaster, can trigger intestinal damage.
Once diagnosed, annual follow-up with your physician is necessary to monitor nutritional deficiencies and your compliance with a gluten-free diet, as well as assess for associated conditions.
Finding the Right Doctor
Celiac Disease Foundation can help you find the right doctor to discuss symptoms, diagnose, and treat celiac disease. Our nationwide Healthcare Practitioner Directory lists primary care physicians and specialists,and dietitians and mental health professionals, experienced in celiac disease and non-celiac wheat sensitivity.