Celiac Disease in Children

Celiac disease in children can adopt multiple manifestations that can delay its diagnosis. Today we'll tell you everything you need to know about the disorder during childhood.
Celiac Disease in Children

Last update: 09 July, 2021

Celiac disease in children manifests itself with greater intensity than in adults. For a long time it was even thought that it was a specific disease for this age, although today we know that its prevalence is much wider.

Given the associated complications, parents and guardians should be aware of its symptoms. This way they can identify them and seek medical assistance and get a diagnosis.

Gastrointestinal problems aren’t uncommon during the first years of life. In turn, this autoimmune disorder can also develop with unusual signs. All this makes detecting it a lot more complicated, although, with what we’ll tell you today, you’ll be able to clear up many of the questions you may have as regards celiac disease in children.

Symptoms of celiac disease in children

Celiac disease in children causes several symptoms
The symptoms of celiac disease in children can be very varied, including mild oral manifestations.

The first thing you should know is that celiac disease during childhood manifests itself with many different symptoms. These will also vary according to the age group. Some children only develop one sign, such as tooth enamel wear, while others will have many intense symptoms. There’ll even be those who pass by under the radar due to asymptomatic celiac disease or the latent variant.

In typical cases of celiac disease in children, however, several symptoms are common. Following the Celiac Disease Foundation’s guidance these are the most common signs according to each stage:

Symptoms in infants and young children

Celiac disease in young children usually begins between 6 and 9 months of age. That is, when solid foods are introduced into their diet. The symptoms they develop are very obvious and are primarily focused on the gastrointestinal area:

  • Abdominal distention
  • Diarrhea
  • Vomiting
  • Flatulence with stench
  • Swelling
  • Malnutrition

Irritability and poor growth are also frequent. This happens because the process of absorption of the nutrients is constrained due to the atrophy of the villi in the intestine.

Symptoms in school-age children

This is the most common group of celiac disease in children. After all, they have had a prolonged exposure to gluten. This allows the physiological processes that are produced in their bodies to become more consolidated, including atrophy in their intestines. These are the symptoms they may have:

  • Stomach pain
  • Diarrhea
  • Constipation
  • Difficulty gaining weight
  • Slow growth
  • Bad smelling flatulence

Obesity can also occur, although these are less frequent. There may also be nausea, anemia, and tooth enamel defects.

Evidence further indicates that attention deficit hyperactivity disorder (ADHD) can also develop. The episodes of irritability and personality changes are also recurrent.

Symptoms in older children

When young people are about to enter puberty or are already adolescents, the symptoms evolve and can no longer be associated with a gastrointestinal problem. These episodes are considered atypical and are caused by several years going by before a correct diagnosis is made. The symptoms in this case are the following:

  • Stunted growth
  • Short stature
  • Chronic fatigue
  • Ulcers in the mouth
  • Rashes
  • Headaches
  • Pain in the bones and joints
  • Anemia

Emotional disturbances, such as anxiety, depression, and panic attacks, can also occur. Irritability and sudden personality changes are not uncommon.

Diagnosis of celiac disease in children

As you can see, there are no clear indications that indicate the presence of celiac disease in children. Even during the first year of life, the symptoms can be confused with other conditions. It is here when risk groups play a leading role in moving towards an accurate diagnosis.

An article published in Clinical Gastroenterology and Hepatology in April 2011 suggests that up to 40.6% of childhood celiac disease cases occur in children with first-degree relatives with the condition or diagnosed autoimmune disorders.

In turn, research published in The Journal of Pediatrics in July 2013 indicates that children with Down syndrome are up to six times more likely to contract the disorder. Those who are in these risk groups and experience some of the symptoms should go to a specialist to start the diagnostic process.

This process is no different from the adult stage: serological tests, DNA and endoscopy are still the most effective methods to detect the disease.

Even so, some studies indicate that up to 10% of celiac disease cases in children have negative serological results on the first test. These evolve to positive results during successive tests.

The reason for this is that although serology is a proven method, it needs the confirmation of a biopsy for a definitive “yes”. In turn, because the disorder may still be in its initial stages, detecting it months or years after the presence of symptoms is easier.

Treatment of celiac disease in children

Celiac disease in children can be treated
Once the diagnosis has been confirmed, it’s important to restrict gluten consumption to avoid the condition worsening.

As Coeliac UK reminds us, a follow-up is necessary every six months after diagnosis to assess the child’s condition. When the doctor deems appropriate, it will be performed just once a year and then only occasionally when the disorder is under control.

Researchers stipulate that a gluten-free diet is the only effective treatment for celiac disease in children. After the condition has been detected, the consumption of wheat, barley, rye and other products that contain the protein should be avoided. By doing this, the symptoms will disappear and the lining of the intestine will recover (this may take several months).

Unfortunately, gluten isn’t only present in food. The Children’s Hospital of Philadelphia also points out that other products that may contain it are the following:

  • Plasticines
  • Crayons or paints
  • Adhesive for stamps and envelopes
  • Shampoos, powders and other hygiene products
  • Mouthwash and toothpaste

We recommend that you read the labels well to completely rule out the presence of gluten. Even if they don’t ingest it, some patients can manifest symptoms even with external contact. It’s very important that the diet to be implemented is mediated by a specialist, thus ensuring that it supplies the necessary nutrients during this important stage of development.

  • Garnier-Lengliné H, Cerf-Bensussan N, Ruemmele FM. Celiac disease in children. Clin Res Hepatol Gastroenterol. 2015 Oct;39(5):544-51.
  • Mårild K, Stephansson O, Grahnquist L, Cnattingius S, Söderman G, Ludvigsson JF. Down syndrome is associated with elevated risk of celiac disease: a nationwide case-control study. J Pediatr. 2013 Jul;163(1):237-42.
  • Niederhofer H. Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. Prim Care Companion CNS Disord. 2011;13(3).
  • Tosco A, Salvati VM, Auricchio R, Maglio M, Borrelli M, Coruzzo A, Paparo F, Boffardi M, Esposito A, D’Adamo G, Malamisura B, Greco L, Troncone R. Natural history of potential celiac disease in children. Clin Gastroenterol Hepatol. 2011 Apr;9(4):320-5.
  • Van Kalleveen MW, de Meij T, Plötz FB. Coeliakie op de kinderleeftijd [Coeliac disease in children: a changing clinical spectrum]. Ned Tijdschr Geneeskd. 2019 Mar 19;163.

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