Celiac Disease: Pediatric Implications

B.S. Dietetics, Dietitian, Health Professional
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About one in every 133 people in the United States has celiac disease, an autoimmune disease in which the body mounts an immune response to ingestion of the protein gluten.

Gluten is found in wheat, rye and barley. Children with celiac disease face additional complications because their bodies are constantly growing. That makes it even more important to address celiac disease promptly and correctly in all pediatric patients.

These are a few things you will want to keep an eye on if your child has celiac disease:

Digestive damage

When a person with celiac disease eats gluten, the corresponding immune response from the body can lead to damage in the intestine. This damage can cause extreme pain for the patient. Symptoms include abdominal pain, vomiting, diarrhea, constipation, weight loss, fatigue, joint pain and even iron deficiency.

Malnutrition

The damage caused by celiac disease affects nutritional status in two ways. First it can prevent the proper nutrients from being absorbed due to the inflammation and damage in the GI tract. The secondary issue of pain may also cause the child to refuse to eat. Inadequate calories or not eating enough of the healthy foods needed can both cause issues with proper growth.

Bone health

Bone growth and health is built during childhood, which is why you will often hear osteoporosis referred to as a “pediatric disease with geriatric consequences.” By age 18 in girls and age 20 in boys, 90 percent of peak bone mass has already been acquired. That means that any issues with absorbing the essential nutrients for bone health, as seen in celiac disease, can have long term consequences.

Growth issues

It is probably quite obvious that malnutrition and poor bone health over time will affect overall growth. That is one of the ways that celiac can effect growth, but yet another involves developing hormones. The body needs adequate nutritional status for a child to develop through puberty as well as for the production of adequate growth hormones. If that nutritional status is not met then puberty and growth may both be delayed. Up to 10 percent of children with idiopathic short stature may have celiac disease as detected through blood testing.

Social implications

Social implications may be the last thing on a parent’s radar but can be extremely important to a child’s self-esteem. Missing school, not being able to eat what their friends are eating and having to make frequent bathroom breaks can be rough for any child.

Keeping an open dialog with your children can help them express their feelings and can help you to catch any issues with bullying. Bullying because of food allergies has been on the rise in the U.S. While celiac is an autoimmune disease and not a true food allergy -- the bullying is still the same. Check out the Food Allergy Research and Education’s campaign to stop this type of bullying and promptly address and issues with your child’s school. Finding a support group for celiac patients can also be helpful in negotiating these social issues and can make your children feel less alone in their condition.

Knowing some of the implications of celiac disease in pediatric patients can help parents advocate for the best care for their child. Giving information on an age appropriate level can also help children to better understand why they should maintain their gluten-free diet.

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Jennifer has a bachelor's degree in dietetics as well as graduate work in public health and nutrition. She has worked with families dealing with digestive disease, asthma and food allergies for the past 12 years. Jennifer also serves the Board of Directors for Pediatric Adolescent Gastroesophageal Reflux Association (PAGER).