The Symptoms of Celiac Disease in Children and Teens

Celiac Disease is an autoimmune condition where the body cannot digest a protein known as gluten. Attempts to eat gluten in people with Celiac Disease cause damage to the small intestine. The condition can cause a variety of symptoms. Celiac Disease is also known as "Celiac Sprue", and "Gluten-Sensitive Enteropathy".

The treatment for Celiac Disease involves the complete avoidance of all gluten-containing foods. Gluten is found in wheat, barley, rye and oats, and many prepared foods. If your child has celiac disease, you (and eventually they) will have to read labels carefully, because it is only by totally omitting gluten permanently from the diet that the celiac child will return to health.

What causes celiac disease?

Celiac Disease is a mostly-genetic condition. A child who develops celiac disease has probably inherited one of the two genes linked to the condition from one or both parents. In people with celiac disease, around 95% have the HLA-DQ2 gene, while 5% have the HLA-DQ8 gene.

The likelihood of developing Celiac Disease is increased if your child has another autoimmune disorder, such as a thyroid condition, or Type 1 Diabetes.

What are the symptoms?

The symptoms, while broadly the same, do vary depending on age. The average celiac has to suffer for eleven years before being diagnosed. Here, we'll look at how symptoms vary between younger and older children and what you should do if you think your child might be a celiac.

Celiac Disease in Toddlers

Babies and toddlers aged 9-24 months most commonly present with "typical" symptoms of Celiac Disease. Symptoms usually begin after gluten-containing foods are introduced into the diet.

Infants in this age-group present with:

• Diarrhoea
• Anorexia (loss of appetite)
• Abdominal distension
• Abdominal pain
• Weight loss, or failure to thrive (not gaining correct weight)
• Vomiting
• Behavioural changes (previously happy babies may become "cranky" and withdrawn)

Delayed diagnosis may cause additional symptoms:

• Malnutrition (signs of malnutrition in babies include: lethargy, loss of muscle tone, and hair loss)

Severely-affected babies may suffer celiac crisis, which presents with these symptoms:

• Watery diarrhoea
• Dehydration
• Lethargy
• Severe hypokalaemia (severe potassium deficiency; diagnosed by blood test)

Celiac Disease in Children

Older children may present with symptoms at any age. The severity and age of onset may depend on a number of factors, including the amount of gluten in the diet, and the length of time the child was breastfed. If gluten is introduced while the child is being breastfed, the child will usually start to experience symptoms later, and may have fewer gastrointestinal-related symptoms.

READ Celiac Disease Vs. Non-Celiac Gluten Sensitivity

Even if the child is not having many gastrointestinal symptoms, gluten still needs to be completely eliminated from the diet.

Symptoms in children may be milder and include:

• Nausea
• Recurrent abdominal pains
• Bloating
• Constipation
• Intermittent diarrhoea
• Poor growth
• Fatigue
• Delayed puberty
• A rash called Dermatitis Herpetiformis (itchy blisters, mainly on the knees, elbows and buttocks)

Celiac Disease And Adolescents: What To Do

Celiac Disease and Adolescents

An increasing number of adolescents are diagnosed with Celiac Disease. However, unlike younger children and babies, they're presentation is generally more "atypical", with up to 70% of Celiac teenagers diagnosed with predominantly extraintestinal symptoms.

In Celiac Adolescents and young adults, the most common symptom is:

• Anaemia:
  • iron-deficiency anaemia: a lack of iron, caused by poor absorption and causing
    • weakness
    • tiredness
    • breathlessness
    • headaches
    • pale skin
    • anorexia (loss of appetite)
    • weight loss
  • pernicious anaemia: a lack of B12, caused by poor absorption; causing
    • extreme fatigue,
    • mouth ulcers
    • depression
    • sore tongue
    • irritability
    • paraesthesia (pins and needles)
  • folate-deficiency anaemia: a lack of folate (the natural form of folic acid); caused by poor absorption, causing:
    • reduced sense of taste
    • diarrhoea
    • muscle weakness
    • numbness in the hands and feet
    • depression
    • other general anaemia symptoms (such as fatigue)

Other symptoms include:

• Dental enamel defects
• Short stature
• Juvenile Chronic Arthritis (Celiac Disease is present in up to 3% of teens with this condition)

Any gastrointestinal symptoms (such as nausea, abdominal pain or constipation) tend to be minor.

I think my child is celiac.

If you think your child is celiac, you should book an appointment with your child's doctor. This is particularly important if your child:

• Is small or underweight for their age
• Has lost weight
• Has a close biological relative with Celiac Disease (a parent, sibling, grandparent, aunt/uncle)
• Has chronic constipation or recurrent diarrhoea/abdominal pain/vomiting
• Has not begun puberty at the usual time
• Has anaemia that has not improved with treatment
• Has one of the following conditions:
  • Type 1 Diabetes
  • Down syndrome
  • Turner Syndrome
  • Autoimmune thyroiditis
  • Williams Syndrome

Testing for Potentially-Celiac Children

If your doctor suspects that your child has Celiac Disease, they will run several tests.

This is because eradicating gluten before the tests may cause false results.

Some tests are:

• The tTG (or tissue transglutaminase) antibody test. The level of antibodies will almost always be high in people with Celiac Disease, but is almost never raised in people who don't have Celiac Disease. If tTG antibodies are high, a small intestine biopsy may be recommended.
• Small intestine biopsy: this is the usual follow-up if the tTG antibody test revealed high levels of tissue transglutaminase. A small camera is passed down the throat (endoscopy) to take small biopsies (samples) of tissue. The biopsies don't hurt, but sedation should still be offered.

In the UK, the gold-standard of diagnosis is for the antibody blood-test be repeated before confirming the diagnosis with a genetic test, rather than subjecting a child to a biopsy. This reduces waiting times and allows children to start treatment sooner.

My child is celiac. What do I do?

If your child is celiac, they will require a completely gluten-free diet. This means:

• Finding gluten-free substitutes for favourite foods
• Learning how to read labels
  • Stabilisers and emulsifiers might contain gluten
  • "Wheat-free" does not mean "gluten-free"
  • "Low-gluten" is not the same as "gluten-free" - many celiacs can have problems with low-gluten food
  • Avoid anything with wheat, barley, rye, and all non-gluten-free oats (some celiacs can't eat gluten-free oats, either)
  • Natural fresh foods, such as vegetables, unprocessed meat, fish, cheese and milk are gluten-free (although many celiac children suffer temporary lactose intolerance)
  • Be aware that wheat may be used as a filler where you don't expect it, such as meringues, sauces, and gravies.
• Teaching your child not to swap snacks at school
• Speaking to your child's school
  • Can they provide a special diet?
  • Do the staff understand the needs of celiac children?
  • If not, can you provide a packed-lunch?

READ Could You Have Celiac Disease And Not Even Know It?

Your child's doctors also have a role to play. This may mean:

• Prescribing a course of vitamins, if your child has significant nutritional deficiencies
• Hosting regular follow-up appointments to check your child's development on the diet.

The good news is that life is getting better for Celiac children all the time. There's a much wider range of gluten-free foods available with staples, and sweet treats available in every supermarket.

By following a healthy, strict gluten-free diet, your child can enjoy a happy, fulfilling life.