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.