Does My Child Have Coeliac Disease
BySam Sullivan | Submitted On July 07, 2010
Gluten is the cause of Coeliac disease, a serious and lifelong auto-immune condition . Gluten is a protein found in wheat, barley, rye, oats, spelt, and other grains . Coeliac disease is genetic so your risk is increased if you have family members who are sufferers. Treatment consists of a gluten free diet for life, which leads to a full recovery in most cases. Many people with Coeliac disease do not realise they have the condition.
In Coeliac disease, the villi that line the gut are attacked and damaged leading to problems with absorption of essential nutrients. Symptoms vary from mild to serious and can include stomach pains, bloating, diarrhoea and nausea. Symptoms are often confused with Irritable Bowel Syndrome or stress. Recognizing and diagnosing Coeliac disease can be a lengthy drawn out process and some people go years before finding a diagnosis and some people are simply never diagnosed and suffer with general ill health. Since the disease can go on for many years undiagnosed there is the risk of developing long-term complications such as anaemia, weight and hair loss, osteoporosis, infertility, joint/bone pain and malnutrition.
Q. Does your toddler/child have more than two of the following symptoms after eating gluten-containing foods: abdominal distension or bloating bone or joint pain flatulence headache, nausea and vomiting?
The common symptoms of gluten sensitivity and therefore possibly Coeliac disease include:
How To Determine If Your Child Has Non
Diagnosis of non-celiac gluten sensitivity , also known as non-celiac wheat sensitivity, is somewhat more difficult compared to other gluten intolerance conditions.
Your child will have to go through a series of tests to rule out celiac disease and wheat allergy before a diagnosis of NGCS is confirmed.
Because the symptoms of irritable bowel syndrome and NCGS tend to overlap, a gluten challenge may be needed to confirm diagnosis, especially if you have not already eliminated gluten from their diet.
In a gluten challenge, your child will follow a gluten-free diet for approximately 6 to 8 weeks. After the gluten-free period, there is an intentional reintroduction of a certain amount of gluten.
If your child has a positive response during the gluten-free period with a return of symptoms after reintroduction of gluten, then your child will likely be diagnosed with NCGS.
Gluten challenges are discouraged in children under the age of 5 years or in their pubertal growth spurt. But it still may be recommended in children already following a gluten free diet in absence of a formal work-up of celiac disease.
Children already following a gluten-free diet without celiac disease diagnosis can receive genetic testing for alleles that show a genetic predisposition for celiac disease.
Other tests can be used to exclude a celiac disease diagnosis and increase likelihood to be diagnosed with NCGS. Participation in a randomized placebo-controlled trial with gluten can further confirm NCGS.
What Challenges Do Pediatric Celiac Patients And Their Families Face
There are many, from a child not growing well to having to deal with dietary restrictions and social isolation. The emotional toll on children with this disease can be enormous. Parents can also struggle, spending hours on the phone talking to food manufacturers, prohibiting any gluten in the home or not allowing their children to go out. This hyper-vigilant state isnt good for the child or the parents.
It’s important to have a medical team you can rely on to say, “Talk me off the ledge.” Follow-up appointments arent just about looking at blood tests, but also looking at the patient as a whole, the family as a whole, and discussing matters like how to handle holidays like Thanksgiving.
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Questions Find Hidden Celiac Disease In Kids
Questionnaire Helps Identify Kids Who Need Gluten-Free Diet
Many children have celiac disease, a disorder that causes damage to the intestines when food containing gluten is eaten. Such kids do much better on a gluten-free diet. Foods containing wheat, oats, and barley give them trouble.
But at least half of kids with celiac disease never get diagnosed, and thus needlessly suffer symptoms such as diarrhea, abdominal pain, and behavior problems.
There’s a blood test that tells doctors which kids likely have celiac disease. But it’s impractical to give all kids the blood test. Might it be easier to test only kids who have one or more symptoms of celiac disease?
To find out, Peter Toftedal, MD, of Odense University Hospital, Denmark, created a questionnaire for parents. The five items elicit information on recurrent abdominal pain, chronic diarrhea, constipation, and lack of height and weight gain:
- Has your child ever suffered from abdominal pain more than twice during the last three months?
- Has your child ever had diarrhea lasting more than two weeks?
- Does your child have a tendency to firm and hard stools?
- Does your child gain enough weight?
- Does your child gain enough height?
How well does it work? Toftedal and colleagues tested the questionnaire on Denmark’s County of Funen. They mailed it to the parents of 9,880 8- and 9-year-olds. Before giving the questionnaire, 13 Funen kids were known to have celiac disease.
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What To Do If Your Toddler Has Gluten Sensitivity
If your toddler shows gluten insensitivity symptoms mentioned above, you should consult a gastroenterologist who will test for celiac disease. Dr. Verma on CHOP says that you should not cut back on the gluten intake before the test. If the celiac disease test is negative, the doctor will test other disorders like bowel problems, intestinal parasites, fructose intolerance, and wheat allergy. If all the tests turn negative, you will try the elimination method. You eliminate gluten foods from your toddler’s diet and observe any changes. If symptoms improve, there is a chance that gluten is the culprit. But to confirm that, you will need to reintroduce gluten to your toddler’s diet. If the symptoms begin again, then your toddler has gluten sensitivity.
The next step is a gluten-free diet. A dietitian should help you create a gluten-free diet for your toddler. You will also need to educate yourself on gluten.
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What Is Gluten And Gluten Allergy
Gluten is the name of a protein that is naturally found in foods like wheat, barley, rye, and semolina. It helps the food maintain its shape, acting as glue. Wheat, rye, and barley are the most common grains containing gluten, and many food products like bread, pasta, cereals, sauces, soups, and malts are made out of them.
If your child is intolerant to gluten and takes foods containing this protein, it can trigger an autoimmune response that might harm the intestines. This can cause long term problems and other autoimmune diseases like thyroid issues, osteoporosis, lymphoma, and osteopenia.
A Physician Administered Blood Test And Genetic Test
A blood test is normally given by your primary care physician when celiac disease is suspected. It looks for immune cells in your blood and at the same time a test that looks for antibodies in your blood. The test most often used is called the tTGIgA
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The test, which is frequently referred to as a screening tester, may be part of a panel of several tests that look for specific antibodies in the blood stream produced by the body when a person who is sensitive to gluten actually eats gluten: endomysial IgA antibodies .
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If the antibodies are positive there is a high likelihood of the presence of celiac disease.
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The test only looks for celiac disease. There is no blood test for gluten intolerance.
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There is some evidence that there are a lot of false negatives in celiac blood tests. Some people with negative blood tests can still have celiac.
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There is also evidence that there may be false positive celiac blood tests. These false positive tests may sometimes indicate another problem such as problems in the esophagus or stomach, ulcers, infection or other autoimmune conditions such as thyroid disease. Thus, it is important to have an endoscopy to confirm the diagnosis of celiac disease.
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How Are Children Of Different Ages Affected By Celiac Disease
Although the symptoms weâve mentioned above can be a sign of celiac disease in children, certain symptoms are more likely to occur in certain age groups. These indicators can often be confused with symptoms for other conditions, such as another autoimmune disease, so itâs important that you know how your child is likely to show signs of the celiac disease depending on age.
Why Is It Important For Celiac Disease Patients To Have Regular Follow
Regular follow-up is needed to assess a patients symptoms, whether they improve on a gluten-free diet, and to assess a childs growth. Follow-up blood work is also needed to gauge diet adherence, possible disease complications and vitamin levels.
Many people diagnosed with celiac disease go online to learn about avoiding gluten they may start a gluten-free diet and feel they don’t need to worry about anything else. But its hard to fully understand your disease and treatment by simply going online. For instance, once youve been diagnosed, your entire family should get tested for celiac disease.
A trusted medical team can help with age-appropriate education about the illness, from nutrition to implementing a 504 plan that ensures a child with celiac disease gets the accommodations they need at school.
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What Are The Signs & Symptoms Of Celiac Disease
Common symptoms of celiac disease are diarrhea, decreased appetite, stomachache and bloating, poor growth, and weight loss. Many kids are diagnosed with it when they’re between 6 months and 2 years old, which is when most kids get their first taste of gluten in foods.
For some people, the problems start slowly and the symptoms may be terrible one week and not as bad the next. Because of this, some people aren’t diagnosed with celiac disease until they’re older. The problem is chronic, which means that although symptoms may come and go, people who have celiac disease will always have it.
Someone with celiac disease may feel tired and could be irritable. Some also have skin rashes and mouth sores. The problem is sometimes mistaken for other digestiveproblems called inflammatory bowel disease or lactose intolerance. And in some cases, a kid won’t have any symptoms and then will all of a sudden start having problems during a time of stress, such as after an injury.
Managing Food Allergies In Children
Because fatal and near-fatal wheat allergy reactions, like other food allergy symptoms, can develop when a child is not with his or her family, parents need to make sure that their childs school, day care or other program has a written emergency action plan with instructions on preventing, recognizing and managing these episodes in class and during activities such as sporting events and field trips. A nonprofit group, Food Allergy Research & Education, has a list of resources for schools, parents and students in managing food allergies.
If your child has been prescribed an auto-injector, be sure that you and those responsible for supervising your child understand how to use it.
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What Will My Child Be Able To Eat
You may be surprised by the variety of foods that your child can eat and thats what our registered dietitians will help you to focus on. A healthy gluten-free diet includes a variety of fresh fruits, vegetables, rice, quinoa, millet, buckwheat, meats, milk, and milk products. There are also breads, crackers, pasta, and desserts that are made from the allowed grains.
Types Of Gluten Intolerance
Types of gluten intolerance include celiac disease, gluten sensitivity and wheat allergy.
Gluten intolerance is a general term for adverse reactions to a protein called gluten, which is found in wheat, barley and rye. Types of gluten intolerance include celiac disease, gluten sensitivity and wheat allergy.
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Symptoms Of Gluten Sensitivity
Compared to people with celiac disease, people with NCGS have more symptoms that are not gastrointestinal in nature. The symptoms may also appear hours to days after consuming gluten. Here are some of the symptoms of gluten sensitivity:
- “Brain fog.” This is the most common characteristic of gluten sensitivity. Kids with brain fog may often feel tired, or like they just got out of bed. They may be especially forgetful, and may have trouble focusing or completing tasks.
- Headaches or migraines. Its not normal for children to experience chronic headaches or migraines. If your child is experiencing these symptoms, he should be taken to a doctor for an evaluation. It could be a sign of gluten sensitivity.
- Dizziness
- Acne or rashes. Itchy elbows, knees, buttocks and the back of the neck has been associated with gluten sensitivity.
- Joint pain or numbness. Chronic joint pain and tingling and numbness in the fingers, arms or legs are clear signs of a health issue. In those with a gluten sensitivity, it happens frequently for no apparent reason.
- Diarrhea, gas or constipation
Testing For Wheat Gluten Allergy
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What Foods Can You Give A Child Who Is Gluten Intolerant
Transitioning to a gluten free diet when your kid is newly diagnosed with a gluten intolerance can seem intimidating. But there is actually a lot of variety in a gluten free diet for kids.
To start, there are food groups when purchased in their fresh and natural forms, that are inherently gluten free:
- Meat and poultry
Why Do Some People Feel Better On Gluten
Gluten sensitivity is real. When people who test negative for celiac disease say they feel better on a gluten-free diet, it may not be the absence of actual gluten leading to improvements in their symptoms.
When you take away wheat, rye and barley, diets become low in FODMAPs. FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are carbohydrates and sugars that are poorly digested and absorbed, and theyre often found in foods that contain gluten.
People with sensitive GI tracts may feel better when on diets low in FODMAPs these diets are most often used as part of treatment for irritable bowel syndrome.
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What Are The Symptoms
If your toddler has coeliac disease, hell probably show symptoms within a few hours. You may notice an excessive amount of irritability and crying, which can be quite similar to the signs of colic.
The classic symptoms of coeliac disease in infants include diarrhoea, bloating and tiredness, says Nicola. Faltering growth and a failure to thrive are other signs.
Also keep an eye on your tots unwillingness to eat. If he is sensitive to gluten then he may associate eating with pain.
If the symptoms arent that severe but are present your tot could have non-coeliac gluten sensitivity. The symptoms of this may be similar to those experienced by many people with coeliac disease, says Nicola. But it is not clear how the immune system might be involved and there does not appear to be the typical damage to the lining of the gut.
How Do You Know If Your Child Has A Gluten Intolerance
The first step to determining if your child has a gluten intolerance is to see if they have any symptoms. Gluten intolerance in kids can manifest a variety of symptoms depending on their age.
Infants and toddlers primarily have gastrointestinal symptoms with gluten intolerances such as vomiting, abdominal distention, diarrhea with smelly stools, and bloating. Additional symptoms may include poor growth or failure to thrive and irritability.
Young, school-aged children may still have some gastrointestinal symptoms such as diarrhea, constipation, abdominal distention, and stomach pain. These children may also experience dental issues, weight loss, difficulty gaining weight, or short stature.
Adolescents and teenagers may exhibit more symptoms that are related to nutrient deficiencies and growth delays. Common symptoms include weight loss, stunted growth, delayed puberty, chronic fatigue, headaches, skin rashes, mood disorders, and mouth sores.
If your child is exhibiting some of these symptoms after eating certain wheat or gluten-containing foods, then it may be necessary to get a formal assessment of their gluten tolerance.
Wheat allergies are confirmed by skin prick tests for allergies and serum IgE antibodies to wheat allergens, followed by a gluten challenge.
Celiac disease is confirmed by presence of TG2-specific autoantibodies and endomysial antibodies , as well as biopsy results showing villous atrophy within the small intestine.
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