Celiac disease in children, also called juvenile celiac disease, is a growing epidemic. Although the disease affects more and more children every year, many parents and caregivers are still unaware of the early signs of this potentially dangerous condition. Even if a child is exhibiting the key symptoms of a gastrointestinal disorder, many parents and caregivers brush off the signs as something the child will grow out of over time. This approach is unfortunately often mirrored by doctors, who may diagnose the child with temporary issues such as GERD and other disorders.
To help you discover whether your child may have celiac disease we have put together this article which will take you through the general symptoms that are most likely to appear in each age group, and potential risk factors. If it turns out that your child’s symptoms are similar to those we mention in this article, you may also consult with your family doctor.
Before you do that, though, it’s worth reading this article to see whether the symptoms your child is experiencing are in line with celiac disease symptoms.
What is gluten?
One of the biggest misunderstandings about gluten is that it is nothing more than another word for wheat. Wheat certainly is one grain with gluten. However, it isn’t the only food item in the gluten bracket. Gluten is a protein found in wheat, rye, spelt and barley and hybrid grains. The two main ingredients in this protein are glutenin and gliadin. It is the latter that is responsible for the majority of negative side effects people with celiac disease experience.
The primary reason why gluten is used in foods is because of its ability to help food maintain its shape. It basically acts as a glue. It is this feature that gave gluten its name to begin with. The ingredient itself is found in a number of different foods, even those you might not expect, so it is important to check all labels if you are exploring the possibility of your child suffering from celiac disease.
Most people are shocked to learn that gluten is also found in a number of other everyday products such as medications, vitamins, adhesives for stamps and envelopes, and cosmetics. All are products celiac sufferers need to avoid.
What is celiac disease in children?
Celiac disease is thought to affect one in 100 children in the US, making it one of the most common conditions suffered by children across the country. Some researchers believe the statistics could be even higher, suggesting it could be even more prevalent than type 1 diabetes. Like type 1 diabetes, celiac disease is also an autoimmune disease. It affects digestion, making it difficult for people to digest gluten due to hypersensitivity.
If a child suffers from celiac disease, the condition may lead to damage in the small intestine, and interference with the absorption of nutrients from food. Left untreated, these symptoms may lead to irreversible damage, which is why diagnosing celiac disease in children is so important. The most common age for diagnosis, if done before adulthood, is between the ages of 6 months and 2 years. It is during this time that many children are introduced to gluten for the first time, and symptoms become apparent. There is also another spike in diagnosis when someone reaches adolescence. Some people, however, wait until adulthood to be diagnosed when symptoms tend to be severe and have a significant impact on the person’s life.
If you think your child might have celiac disease and is older than the youngest age for diagnosis, it is important to know that this isn’t your fault. In some children, there are no symptoms for a long time. Even when symptoms are present, they can be explained away as other conditions and are often not taken seriously.
Why do children get celiac disease?
Research into celiac disease in children is still in the very beginning stages, so it’s likely that we’ll see more theories and hypotheses in the coming years. However, early research has revealed a relationship between two genes and celiac disease. These are HLA-DQ2 and DQ8. If a genealogy or other blood test shows you have either of those genes, you are more likely to have or acquire celiac disease. This link has also led many researchers to believe that family history may be the reason children get celiac disease. In fact, if one of your child’s first-degree relatives (parents or siblings) has celiac disease, there is a 1 in 10 chance that your child will develop the disease.
Some researchers believe that those who are not exposed to gluten during the weaning process may be at an increased risk of developing celiac disease. This is why it’s often not recommended to start your child on a gluten free diet without intervention and guidance from a doctor. Additionally, there are links between celiac disease and a number of other conditions and syndromes. We will list them independently later in this article.
Celiac Disease Symptoms in Children
When it comes to visiting a healthcare professional to discuss concerns about your child’s potential for celiac disease, it is always best to go armed with as much knowledge as possible. No list can be comprehensive enough to reveal all the potential abnormal symptoms your child may experience. However, here are the most common symptoms you are likely to encounter with your child.
One of the first symptoms of celiac disease in children is loose and watery stools.
This symptom often occurs when children are introduced to solid foods for the first time, but it can continue for a long time if celiac disease isn’t diagnosed.
The cause of the diarrhea is said to be because of something called malabsorption, where the body cannot fully absorb nutrients. This also leads to stools that contain abnormally high levels of fat, which makes them smell worse and have a greasy appearance.
Diarrhea isn’t only common in children; one report found that 79% of people had diarrhea before being diagnosed with celiac disease. This condition dropped to just 17% after treatment commenced.
The good news is that diarrhea symptoms will begin to reduce in frequency a few days after gluten is excluded from your child’s diet.
Most people find they are completely symptom free after four weeks.
In the early stages of research into celiac disease in children, it was believed that only those with chronic watery diarrhea could have the condition. Further research has revealed that many children with celiac disease also suffer from either alternating constipation and diarrhea, or constipation on its own. In one study that took place at the Digestive Disease and Nutrition Center, medical professionals examined children who had been diagnosed with celiac disease in the previous 10 years. Of those children, 39% exhibited constipation as a symptom at the time they were diagnosed. This is more than the 31% of children presenting with diarrhea. Though this pattern doesn’t fit with what’s considered ‘normal’, researchers do acknowledge that celiac disease in children commonly presents itself this way.
If children have symptoms other than constipation that may indicate a potential celiac diagnosis, doctors would often recommended further testing to definitively rule the condition in or out. The good news is that, like diarrhea, symptoms of constipation will often clear up once a child is placed on a gluten free diet.
In untreated presentations of celiac disease in children, excessive gas is a common side effect that comes from irritation to the small intestine. Although this is especially common in younger children, in some cases it can occur in adolescents and teenagers. In one small sample study, gas was one of the most common symptoms caused by gluten consumption in sufferers of celiac disease.
Gas does not always indicate someone is experiencing celiac disease, however. More common reasons your child may be exhibiting these symptoms include: constipation, indigestion, and conditions such as lactose intolerance and irritable bowel syndrome.
There are a few different factors that can cause bloating, but in cases of juvenile celiac disease, bloating normally occurs after eating gluten. You can tell if someone is bloated because the abdomen will appear swollen and distended after one has eaten gluten-containing foods. The child might tell you that his/her stomach hurts. The reason this is so common in sufferers of celiac disease is because the condition causes inflammation in the digestive tract.
There’s no need to worry if your child experiences bloating, however. It is an extremely common symptom: 73% of those with celiac disease reportedly feel bloated before receiving their celiac disease diagnosis. Various studies have found that bloating is eliminated from a child’s symptoms list almost immediately after removing gluten from the diet, so it isn’t difficult to reverse this condition if your child is experiencing bloating.
Although less common than some of the symptoms mentioned, celiac disease in children may also present itself with decreased appetite. This is usually a symptom found in younger children and appears when they begin to associate pain with certain foods. As a result, your child may choose to avoid certain foods or go without food for longer periods to avoid the pain associated with eating. This can also occur in older adolescents and teenagers, but should not be mistaken for an eating disorder. This condition, as with others in this list, often resolves itself once the patient is put on a gluten free diet.
Itchy Skin Rash
Celiac disease in children may lead to a skin condition called dermatitis herpetiformis, a type of skin rash that results in blistering and itchy skin. It is so commonly found in celiac patients, that some people call it gluten or celiac rash. The condition can appear on the elbows, knees and buttocks. It tends to be symmetrical, meaning that it is most likely to appear on both sides of the body in the same way. When the rash subsides, which it will usually do spontaneously, it often leaves behind brown or pale marks where skin pigmentation has been lost. This condition is thought to affect around 17% of celiac disease sufferers and is often a tell-tale sign that leads to diagnosis. It can also be a sign of poor adherence to treatment. Fewer than 10% of celiac disease patients who develop this skin rash experience the usual digestive symptoms of celiac disease.
If your child has a rash and is also experiencing other symptoms, it doesn’t rule out celiac disease, but may make conditions like eczema and lactose intolerance the more likely culprits.
Recurrent Headaches or Migraines
Recurrent headaches or migraines are another common symptom of celiac disease in children, but they are most common in undiagnosed adolescents, teenagers and adults. Though an occasional headache is completely normal for a child, regular headaches could be a sign of something more serious. One study found that the mean prevalence of headaches in celiac patients was 26 percent, significantly higher than the rate for the general population. Studies into why recurrent headaches and migraines are often co-morbid with celiac patients is ongoing, but early reports have lead researchers to a few preliminary explanations for why this might occur. One theory is that, like celiac disease, migraines also seem to run in families, and therefore some people unfortunately suffer from both. The two conditions also tend to have overlapping symptoms: fatigue, diarrhea, constipation, and bloating. Perhaps having one condition may make the chances of developing the other higher.
Since celiac disease prevents the absorption of nutrients in the small intestine, it can lead to iron-deficiency anemia that doesn’t respond to supplements and is caused by a lack of red blood cells in the body. Symptoms of this version of anemia include fatigue, weakness, chest pain, headaches and dizziness. Although it is usually a symptom associated with more severe celiac disease, a study of 34 presentations of celiac disease in children found that nearly 15% had mild to moderate iron-deficiency anemia. In a larger study, more generalized towards celiac disease sufferers of all ages, it was found that 23% were anemic. The same study also reported that those who did suffer with anemia were twice as likely to have severe damage to the small intestine, as well as loss of bone mass as a result of the condition. Results from the study mentioned above may indicate why iron-deficiency anemia is most commonly found in teenagers and adults who have been living with undiagnosed celiac disease for some time.
When someone with celiac disease eats gluten, the immune system races into action, causing inflammation. The inflammation can then go on to affect the body’s organs and other tissues, potentially leading to joint pain. In cases of celiac disease in children, joint pain can also be caused by a lack of nutrients reaching the bones, leading to stunted growth. Someone who has not been treated for celiac disease for several years after being symptomatic may develop a severe case of celiac disease – resulting in osteoarthritis. This is a permanent condition that may be helped by physiotherapy and other treatments, but it cannot ever be cured.
Weight loss in children with celiac disease isn’t uncommon. It can be caused by a decreased appetite but since this isn’t the only reason it occurs, weight loss could also be viewed as another symptom. Usually, weight loss occurs because the child’s body is unable to absorb nutrients, possibly leading to malnutrition and thus, weight loss. In one study containing 112 participants with celiac disease, it was found that weight loss was a symptom for 23% of them and was one of the most commonly reported symptoms after diarrhea, fatigue and stomach pain. Another study found that introducing a gluten-free diet significantly increased body weight. At the same time, it’s important to note that weight loss doesn’t only occur because of celiac disease. If your child is suffering from weight loss without any other symptoms, it could be due to other conditions: diabetes, cancer, depression and even thyroid problems.
Though not commonly associated with celiac disease, one symptom found in teenagers tends to be delayed puberty. Some studies have found that girls with untreated celiac disease were far less developed at puberty than girls with celiac disease who were following the diet. Females aren’t the only ones who suffer, though. The same studies have found a reduced serum level of dihydrotestosterone and an increased serum level of luteinizing hormone in males with celiac disease, suggesting androgen resistance. Androgens are a group of hormones that play a role in reproductive activity in males. Androgen resistance may lead to higher infertility and delayed sexual maturity for male teenagers.Researchers aren’t quite sure why this happens. One theory is that resistance occurs due to antibodies that are directed against the hormones or organs critical for puberty development.
Since malnutrition is another symptom of celiac disease in children, adolescents and teenagers, this condition could inhibit and delay puberty in both genders.
Decreased energy levels and chronic fatigue are extremely prevalent symptoms of celiac disease. One study even found that those with untreated celiac disease had significantly more problems with fatigue and fatigue-related symptoms than those following a successful gluten-free diet. One reason given for this symptom is that the damage untreated celiac disease does to the small intestine leads to vitamin and mineral deficiencies. These deficiencies, in turn, leave people with less energy, making them feel fatigued over a long term. A high prevalence of people who suffer from sleep disorders also fit the celiac disease criteria, which may also contribute to high fatigue levels for sufferers.
Not surprisingly, celiac disease is also linked to depression, another symptom that can be responsible for high levels of fatigue and a lack of energy.
When most people think of symptoms associated with celiac disease, they often only consider physical symptoms. However, psychological mood disorders such as depression can be extremely common, even in juvenile celiac disease. A study of 2,265 celiac patients found that 39% suffered from depression. Another small study backs up these findings, reporting that those with celiac disease are far more likely to suffer from depression and similar disorders than a healthy control group.
The good news is that the study involving 2,265 celiac patients found that sticking to a long-term gluten free diet alleviated depression symptoms.
If your child is tested and diagnosed early enough, you may be able to help him or her avoid developing depression altogether.
Which Children Need Testing For Celiac Disease?
Although celiac disease in children is not uncommon, and any child can be diagnosed with the condition, there are some risk factors that you should be aware of. If your child suffers from certain conditions, for example, it might be a good idea to request a test for celiac disease, if this had not already been done.
The conditions or syndromes below are often associated with a child also developing celiac disease.
- Down’s Syndrome
- Type 1 Diabetes
- Selective IgA Deficiency
- Turner’s Syndrome
- William’s Syndrome
- Autoimmune Thyroiditis
- Juvenile Chronic Arthritis
Additionally, If you have a family history of celiac disease or have had genealogy testing that suggests you could potentially pass on the condition to your child, then you should also consider testing them for the condition.
Lastly, you should also test your child for celiac disease if you think they may be experiencing any of the symptoms already described.
How Are Children of Different Ages Affected By Celiac Disease?
Although the symptoms we’ve mentioned above can be a sign of celiac disease in children, certain symptoms are more likely to occur in certain age groups. These indicators can often be confused with symptoms for other conditions, such as another autoimmune disease, so it’s important that you know how your child is likely to show signs of the celiac disease depending on age.
Celiac Disease For Small Children (Before Age Two)
Celiac disease in children is often diagnosed before the age of two. This is because the symptoms of the condition tend to be most obvious during this time when children are first introduced to gluten in their diet. One of the most common symptoms of celiac disease in children of this age is failure to thrive, which refers to poor growth and weight loss. The condition usually worsens once solid foods have been introduced. This is a severe symptom and should lead to immediate investigation by medical professionals.
Other symptoms commonly recorded among children under the age of two include:
- Abdominal distention
You may also find that these symptoms worsen as the months go on, and the child is weaned off milk and increasingly relies more on solid food to receive the necessary nutrients for growth. This is because celiac disease makes it difficult for the body to consume nutrients, possibly causing your child to become malnourished if the condition is not detected early.
Celiac Disease in School-Age Children
Although celiac disease in children is usually diagnosed early, many won’t receive a diagnosis until far later, at which point their symptoms have become much milder. It is far less likely for school-age children to experience vomiting as a result of celiac disease, but there are other symptoms that could be potential warning signs. These symptoms include:
- Stomach aches or abdominal pain
- Abdominal distention
- Difficulty gaining weight or sudden weight loss
If you notice your child’s gas is particularly offensive, this can also be another warning sign of a more serious condition.
You should also look out for signs that a child isn’t growing at a normal pace, especially if the child falls off the percentile given at birth. This is a common sign of celiac disease in children that could mean they aren’t getting enough nutrients to continue growing.
Celiac Disease for Adolescents & Teenagers
If someone reaches adolescence or the teenage years without a diagnosis of celiac disease, they may have developed signs that are not directly related to the intestinal tract. Celiac disease in children of this age is much harder to treat, because the signs tend to be more subtle. Most doctors, however, will investigate the potential for an adolescent or teenager to be suffering from celiac disease if they have one or more of the following symptoms:
- Stunted growth
- Weight loss
- Delayed puberty
- Achy pain in the bone or joints (a potential sign of osteoarthritis)
- Chronic fatigue
- Recurrent headaches or migraines
- Dermatitis herpetiformis, or itchy rashes on the skin
- Recurring mouth sores
Adolescents or teenagers may also receive elevated liver function tests depending on the severity of their condition at the time of their diagnosis.
Due to links between the brain and the digestive system, adolescents with celiac disease are also at an increased risk of developing mood disorders such as anxiety and depression, and even panic attacks.
While these won’t be enough to trigger investigations on their own, if accompanied by other symptoms mentioned above it might be worth a doctor visit to investigate the potential overlap.
High Risk Children & Teenagers
Despite the different symptoms for different age groups, it is essential to remember that not everyone will show symptoms. This is especially true in those who are already at an increased risk of developing the condition and is one reason why celiac disease in children isn’t always diagnosed early enough. It is also possible that celiac disease in children and teenagers comes with other signs of the disease that are not typical symptoms.
These conditions include:
- High levels of live enzymes or AST and ALT
- Dental enamel defects
- Iron deficiency anemia
Severe Symptoms in All Ages
If celiac disease in children goes untreated for a long period of time, severe symptoms can develop at any age. Symptoms to watch for include:
- Chronic fatigue
- Very low blood pressure
- Electrolyte disturbance from excessive water loss in stools
- Abdominal obstructions
What foods can you give a child who is gluten intolerant?
Celiac disease brings another battle to the table when it comes to ensuring your children receive a balanced diet. Fortunately, it’s not as hard as it used to be. This is partly due to the fact that celiac disease in children and in adults is becoming increasingly common, with prevalence considered to be four times higher than it was fifty years ago. In addition, almost 30% of the population is going gluten free for a variety of reasons, including general health concerns or as a necessary side effect of having celiac disease. These statistics may seem useless, but they have made it much easier to help celiac disease in children cope. This is because most restaurants now have specific gluten-free menus, and many grocery stores have specific sections for gluten-free foods.
The main points for your celiac child you need to be aware of include avoiding products with labels that say, ‘may contain’, and the prevention of cross contamination by thoroughly washing utensils used to make non-gluten-free foods. It is understandable to feel out of your depth or overwhelmed following a child’s diagnosis, or when you are just beginning to question one. Here is a short list of foods to avoid if you are trying to follow a celiac friendly diet:
If your child struggles with completely cutting these things from their diet, you can always swap for one of the many gluten free alternatives now available in shops.
Though the list of foods you can’t eat seems exhaustive, there are a number of foods you should include in a balanced diet when dealing with celiac disease in children. These include:
- Meat, poultry and seafood
- Fruits & Vegetables
- Gluten-free grains, like millet, buckwheat, rice and quinoa
- Healthy fats
- Herbs and spices
As mentioned above, celiac disease is an extremely common autoimmune disease, affecting about 1 in every 100 children. Despite this, rates of late or undiagnosed children are still incredibly high, leading to potentially severe complications for small intestine and general health. If left untreated, the disease can lead to significant symptoms such as bloating, diarrhea and constipation. In younger children, these symptoms of ill health are likely to include vomiting and growth problems that may indicate a failure to thrive. Older children can also experience these issues. However, they are more likely to experience such symptoms as abdominal distention and difficulty gaining weight.
Although physical symptoms are a large part of diagnosing celiac disease in children, it is also important to not overlook the psychological side. If your child begins to become irritable or shows signs of depression in addition to showing digestive concerns, it could be a sign that they are suffering from undiagnosed celiac disease. Even though some of these symptoms could indicate other conditions, people who have a family history of celiac disease or have children with specific conditions such as Down’s syndrome or type 1 diabetes should make sure their child is checked for the condition.
A simple blood test could be used to help determine whether your child is suffering.