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Celiac Disease In Children: Causes, Symptoms, Diagnosis, And Treatment

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Celiac disease in children can negatively impact optimal growth and development. Small intestines are damaged when a child with celiac disease consumes food with gluten. An autoimmune reaction attacks the intestinal villi, small finger-like projections extended to the small intestine lumen.

Villi help in nutrient absorption. Therefore, damages in villi can result in malnutrition, gastrointestinal symptoms, and poor weight gain. Children with celiac disease may not get adequate nutrition even if they consume enough food. Although it is a lifelong condition, eliminating gluten from the diet helps heal the damage and normal absorption of nutrients (1).

Read this post to know about the risk factors, causes complications, and treatments of celiac disease in children.

Causes And Risk Factors Of Celiac Disease In Children

Celiac disease is a genetically inherited disorder, and children may inherit the particular gene for celiac disease from either of the parents. However, many people with this gene never develop the disease. Therefore, the exact cause of celiac disease is unknown (2).

However, celiac disease may be triggered in some individuals by a combination of (2)

  • Having the genes that increase susceptibility to celiac disease
  • Exposure to gluten
  • Exposure to certain toxins
  • Infections (such as rotavirus)

The following conditions may put a child at a higher risk of developing celiac disease (1)

  • Siblings or other immediate relatives with celiac disease
  • Down syndrome
  • Type 1 diabetes
  • Selective IgA deficiency
  • Turner syndrome
  • Williams syndrome
  • Autoimmune thyroiditis

If you, your spouse, or one of your children has celiac disease, your other children have a 10% chance of developing the condition (3).

Types And Symptoms Of Celiac Disease

Celiac disease is classified into three subtypes based on the symptoms (2) (4).

1. Classical celiac disease

It is characterized by the following symptoms of malabsorption:

  • Diarrhea
  • Constipation
  • Nausea
  • Vomiting
  • Steatorrhea (pale, pungent, fatty stools)
  • Reduced appetite
  • Weight loss or poor weight gain
  • Short stature
  • Mouth ulcers
  • Failure of growth in children.

2. Non-classical celiac disease

It is characterized by the following mild gastrointestinal symptoms without evident signs of malabsorption:

  • Abdominal distension
  • Abdominal pain
  • Iron-deficiency anemia
  • Fatigue
  • Severe migraine
  • Peripheral neuropathy (tingly, numb, or aching hands and feet)
  • Elevated liver enzymes or hepatitis
  • Reduced bone density (osteopenia and osteoporosis)
  • Arthritis
  • Frequent bone fractures
  • Folic acid deficiency
  • Vitamin B12 deficiency
  • Difficulty in losing weight
  • Delayed menarche
  • Delayed puberty
  • Unexplained infertility
  • Defects of the dental enamel
  • Behavioral problems
  • Depression
  • Anxiety
  • Skin rashes
  • Seizures
  • Neuropathy

3. Silent celiac disease

It is an asymptomatic form of celiac disease. While patients do not exhibit or report any problems, they have damaged villi in the small intestines. Patients may not have any major symptoms, but they may report better health once they switch to a gluten-free diet. They experience reduced acid reflux, flatulence, and abdominal bloating and distension.

Complications Of Celiac Disease

Celiac disease causes complications only when one continues to consume gluten despite being diagnosed or when they do so because the disease has gone undiagnosed due to mild symptoms. For children in whom celiac disease is diagnosed late, the complications of celiac disease may already be present at the time of initial diagnosis (5).

Potential long-term complications include (6)

  • Weakening of bones (osteoporosis)
  • Lactose intolerance
  • Iron deficiency anemia
  • Vitamin B12 deficiency
  • Folate deficiency
  • Certain cancers such as bowel cancer
  • Problems with pregnancy (underweight babies)

Signs You Should Call Your Doctor

If any of these symptoms continue for more than two weeks, consult a doctor for your child (3). Do not stop eating gluten before seeing the doctor, as it may alter the test results. If a family member has celiac disease, mention this to your doctor as it may guide their choice of screening and diagnostic tests for your child.

Diagnosis Of Celiac Disease In Children

Diagnostic tools such as blood tests, endoscopy, and biopsy diagnose celiac disease in children (3) (7).

1. Blood tests

Blood tests that diagnose celiac disease look for antibodies that show the immune system’s response to gluten. Thus, if the child has not eaten gluten at the time of testing, the blood will not have these antibodies. However, if the child is suspected of having celiac disease, the following blood tests may be prescribed:

  • EMA (anti-endomysial antibodies)-IgA
  • AGA (antigliadin antibodies)-IgA
  • AGA-IgG
  • tTG (anti-tissue transglutaminase)-IgA
  • Total serum IgA
  • DAGL (deamidated gliadin antibody)

2. Endoscopy

If the blood tests are positive, the doctors will perform an upper gastrointestinal endoscopy. In this short procedure, a flexible tube is passed through the child’s throat and guided into the small intestine, where the doctor looks for signs of damaged chorionic villi.

3. Biopsy

The doctor might collect a small tissue sample during endoscopy, which is sent for biopsy. The presence of damaged and inflamed tissue will confirm celiac disease in the child.

If the results of all these tests are unclear, the doctor might perform another blood test to look for the gene that may cause celiac disease in children.

Management Of Celiac Disease In Children

Celiac disease is a life-long condition, and the only way to manage it is to adhere to a gluten-free diet. Eliminating gluten from the child’s diet will improve the symptoms of celiac disease, and once gluten is entirely removed from the system, the intestines will begin to heal.

A pediatric dietician can help in managing celiac disease in children. They will help you understand (8):

  • The safe foods
  • The foods to be avoided
  • How to read a food label
  • The real meaning behind some ingredients
  • Steps to follow when you are unsure if the food is safe for your child
  • How to ensure your child follows a balanced gluten-free diet

Even minute traces of gluten in the child’s diet might hurt their intestine. Hence, consider avoiding the following glutenous food (3):

  • Wheat
  • Rye
  • Barley
  • Oats
  • Bread
  • Cakes
  • Biscuits
  • Breakfast cereals
  • Pizza base
  • Pasta
  • Pastry
  • Crumbed or battered food

Apart from the items listed above, gluten can be hidden in the following (7):

  • Prescription and OTC medicines
  • Makeup products such as lip balms, lip colors, and lip gloss
  • Shampoos
  • Conditioners
  • Lotions
  • Toothpaste
  • Mouthwash
  • Paints
  • Playdough
  • The adhesive in stamps or envelopes

The following measures can help prevent accidental gluten ingestion (3):

1. Store gluten-free food separately at home

  • Prepare and store all gluten-free foods away from glutenous ones.
  • Use separate utensils and chopping boards for gluten-free food.
  • Clean the appliances and utensils used to prepare gluten-containing foods.
  • It can help to have a separate toaster for gluten-free bread to prevent any mixing of crumbs.

2. Read food labels

  • Gluten may be hidden in many foods, including sauces and soups.
  • Look out for the crossed grain logo on food packages, which indicates it is safe for people with celiac disease.
  • Read labels and encourage your child to do so.

3. Keep an eye when dining out

  • Your child can enjoy meals outside, but be extra cautious that they don’t ingest gluten accidentally.
  • Look out for restaurants that enlist gluten-free items on their menus.
  • Inform the staff that your child cannot eat any food with gluten.

4. Choose gluten-free alternatives

  • Look out for brands that make gluten-free cookies, crackers, bread, pasta, and desserts (8).
  • Have a diet rich in fresh fruits, vegetables, herbs, millets, quinoa, rice, buckwheat, milk, milk products, meats, etc.
  • Get creative and do some research to find gluten-free recipes.

Celiac disease is a lifelong condition. Hence, educating your child about the condition, its impact, and how to manage it is essential. Since it may overwhelm them at times, give them emotional support through support groups and ensure their school is informed.

References:

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Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. Dr. Shah's deep interest in the well-being of babies and children... more