Because Celiac Disease (CD) can manifest in various ways, it is often difficult to diagnose. In children, this is more often than not the case, especially with very young children who lack the ability to verbalize their symptoms accurately or at all. While the typical gastrointestinal (GI) symptoms, such as bloating, diarrhea or constipation, and abdominal pain may be present, there are times when these symptoms do not exist. Instead, some children will present with slowed or stunted growth, anemia, or weakened tooth enamel, all resultant of nutrient malabsorption due to the damage CD causes to the lining of the small intestine. Further, CD may also elicit neuropsychological anomolies such as irritability, moodiness, and the inability to focus or concentrate. With such a vast array of symptoms, it is easy to understand why misdiagnosis, particularly in children, can occur.
While random testing of every child is not recommended, children with symptoms of CD should be tested. Further, there are certain groups in which testing is recommended regardless of outward symptoms of CD, such as those with a parent or sibling who tests positive for CD and children with certain disorders such as Down Syndrome, Type 1 diabetes, IgA deficiency, Turner syndrome, Williams syndrome, and thyroid issues. Children with any of these health issues are considered to be at a higher than normal risk of having or developing CD.
If a child is to be tested for CD, he or she should continue to remain on a diet that includes gluten in order to achieve testing accuracy. The initial laboratory test is typically a serological panel that measures levels of antibodies in the blood, specifically anti-tTG (transglutaminase), which are typically high in those with CD if they are on a gluten-containing diet. If the child has high tTG levels, then the diagnosis will need to be confirmed with a biopsy (tissue sample) of the small intestine lining. This is done via endoscopy, a procedure where a small flexible tube is entered into the digestive tract orally to allow the doctor to assess the small intestine lining for signs of damage and inflammation. Children are administered either a mild sedative or general anesthesia, depending on their age and size, that will help to abate any discomfort and allow the child to relax and remain still during the procedure. A biopsy (tissue sample) of the small intestine lining is usually taken during the procedure. Specifically, the doctor will be looking for signs of damage to the small finger-like projections (villi) lining the small intestine. These villi are what allows the body to absorb nutrients from the foods we eat, and in those with CD, the villi are flat and unable to absorb nutrients properly.
Fortunately, once a child with CD is diagnosed and adopts a gluten-free diet, the resilient villi heal and nutrients are readily absorbed through the gut; thus, the troubling symptoms of CD dissipate over time. Children tend to experience an overall improvement in one to two weeks after beginning a gluten-free diet.
The gluten-free diet can, at first, be overwhelming and challenging to parents. With younger children, it is sometimes difficult to convey how serious the effects of gluten can be on their system. In older children, the fear of appearing different around peers can be troubling, not to mention the numerous pizza parties and gluten-filled foods they come into contact with via classroom events, school lunches, or at the homes of friends. To simplify matters, many parents adopt a gluten-free lifestyle for the entire family to avoid the risk of cross-contamination for their child with CD. With so many high quality gluten-free foods commercially available and an abundance of resources on the internet for gluten-free recipes, it is quite feasible to satisfy all family members with a diet free from gluten. However, that does not solve the issue of keeping your child safe when he or she is away from home. With a bit of planning and creativity, this obstacle can be overcome.
More than anything, kids love snacks, but unfortunately, most commercially available snack foods marketed to children contain loads of gluten (not to mention other unhealthy ingredients and preservatives). Replacing the gluten-filled version of your child's favorite snacks with a healthier gluten-free substitute is a great way to help children feel more at ease with their new way of eating. For example, what kiddo (or parent) doesn't love a chocolate cupcake? My recipe for Decadent Chocolate Cupcakes rivals the gluten-laden counterpart and no one will ever guess that they are gluten-free!
There are also many healthy foods that are naturally gluten-free, such as fresh in-season fruits and veggies, nuts and nut butters, sunflower seed butter (in the case of nut allergy), and lean meats and cheeses. Having the kids join you in the kitchen is a great way to create delicious snacks the entire family can enjoy and to achieve a level of comfort for those new to the gluten-free diet!
Up to Date, Inc.
University of California School of Medicine
Akron Children's Hospital
Published On: April 29, 2011