Celiac Disease
Celiac disease is a lifelong digestive condition that is triggered by gluten. When a child with celiac disease eats food with gluten, their body’s immune system mistakenly attacks the lining of the small intestine, which makes it difficult to digest and absorb nutrients. This type of disease is called an autoimmune disorder.
Gluten sensitivity can have symptoms that are similar to those of celiac disease, but it does not have the same typical injury to the intestine. And although wheat is a main source of gluten, wheat allergy is also different from celiac disease.
Girls are more likely to have celiac disease than boys, and children who have Type 1 diabetes are at higher risk for this condition. Celiac disease can also run in families.
Symptoms
Symptoms of celiac disease usually start when the child first eats food with gluten. Your child may have:
- Chronic diarrhea
- Constipation
- Bloating
- Gas
- Nausea
- Vomiting
- Stomach pain
- Fatigue
- Irritability
A few children with celiac disease don't have these symptoms, and the condition can go undiagnosed for years. However, the damage to the small intestine makes it difficult or impossible for their body to absorb the nutrients they need to grow normally. Eventually, celiac disease can lead to weight loss, slowed growth or failure to thrive. It can also damage dental enamel — white, yellow or brown spots on the teeth is sometimes the first sign of celiac disease.
Celiac disease can also lead to these complications:
- Iron deficiency (anemia)
- Thin bones or fractures
- Dermatitis herpetiformis (a chronic, itchy rash)
Diagnosis
Celiac disease symptoms are similar to those of several other conditions, including irritable bowel syndrome and lactose intolerance. This can make celiac disease difficult to diagnose. Your specialist at Orlando Health Children's Arnold Palmer Hospital Center for Digestive Health and Nutrition will ask about your child's symptoms and whether any close relatives have celiac disease.
They will also do a physical exam that can include checking your child's teeth for spots and their body for a rash or signs of malnutrition. Your doctor may listen to your child's abdomen with a stethoscope and check for pain or swelling.
If your doctor feels your child may have celiac disease, they will recommend one or more of the following tests:
Blood tests. These are done to check for substances called antibodies that show your child's body is reacting to gluten in their diet.
Skin biopsy. If your child has dermatitis herpetiformis (skin rash), your doctor may remove a tiny piece of tissue from the rash to examine under a microscope. This can show antibodies related to celiac disease.
Genetic tests. Your child's blood can be tested for genetic changes that occur in people with celiac disease.
Intestinal biopsy. During a test called an upper endoscopy, the doctor takes a small piece of tissue from your child's small intestine to be examined in the lab. With an upper endoscopy, the doctor passes a thin, flexible tube with a camera through your child's mouth to the small intestine while your child is sedated. This biopsy can confirm the diagnosis of celiac disease.
Treatments
To relieve symptoms and avoid damage to their small intestine, your child will need to follow a strict, gluten-free diet. For most children, symptoms greatly improve when they avoid all foods with gluten.
Your registered pediatric dietitian at Orlando Health Children's Arnold Palmer Hospital Center for Digestive Health and Nutrition will help you and your child with the gluten-free diet. They will coach you on which foods contain gluten and how to prepare nutritious meals without them.
You'll learn how to:
- Avoid all foods that contain wheat, rye or barley. This includes most cereals, grains and pastas. Ask your doctor about oats, which may come into contact with gluten during processing.
- Check food labels. Many processed foods contain gluten.
- Find hidden sources of gluten. These can be in products such as nutritional supplements and some medicines. Your child may also inadvertently swallow gluten in toothpaste, shampoo or modeling dough such as Play-Doh.
- Avoid gluten in restaurants. Call ahead to find out if they have gluten-free meals.
- Cook delicious meals without gluten. Meats, fish, fruits, vegetables, rice and potatoes don't contain gluten. Try breads and pastas made with amaranth, quinoa, buckwheat or bean flour instead of wheat flour.
- Different marination sauces and condiments may contain gluten.
- Long term follow up to monitor for healing and nutrition.
Living gluten-free can seem overwhelming at first. But with the growing variety of gluten-free foods, your child's diet will be easier to manage. Most children see their symptoms improve in one to two weeks, and in six to 12 months, the lining of their intestine has healed.
Next Steps
At Orlando Health Children's Arnold Palmer Hospital Center for Digestive Health and Nutrition, you and your child will see a team of healthcare providers who are experts in diagnosing and treating children with celiac disease. Our pediatric gastroenterologists, registered pediatric dietitians and others combine their skills to provide your child with the best possible care. And you’ll see these specialists quickly — appointments for new patients are scheduled within one week, or the next day if necessary.
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