Pediatric Celiac Disease: Children May Have More Psychological Symptoms Than Healthy Peers

B.S. Dietetics, Dietitian, Health Professional
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There is no question that Celiac Disease (CD) can be associated with psychological issues. According to the Celiac Disease Foundation, there are a whole host of mental health conditions that can arise in people who have CD, especially if it has gone untreated. Some of the symptoms include, but are not limited to, depression, anxiety, mood swings, and anger. It is very important to treat CD early to help limit these issues, because it may become more difficult for people to adhere to a gluten-free diet once they experience depression, for example.

The best hope of treating CD early is to look at children who are at a high risk for developing the disease. “Psychological Manifestations of Celiac Disease Autoimmunity in Young Children,” a study published in March, 2017, looked into the psychological functioning in children who tested positive for CD markers and compared them to children in a genetically at-risk population.

The researchers used questionnaires from 4,985 of the almost 8,000 children who had been part of an international study named The Environmental Determinants of Diabetes in the Young (TEDDY) and who fit the CD study requirement. These children either belong to part of a genetically high-risk family or actually tested positive for celiac disease autoimmunity (CDA), which appeared through frequent positive tissue transglutaminase autoantibodies (tTGA). The Achenbach Child Behavior Checklist was used to assess behavior at 3.5 and 4.5 years of age. Some mothers were aware of their child’s CDA status while others were not. The difference helped determine whether that knowledge plays a role in the subsequent accurate reporting of a child’s symptoms.

What researchers found was that children who had undiagnosed CD or CDA were reported to have more psychological symptoms than those without markers for CD. Mothers who were unaware of their child’s CDA status also reported that their child had more psychological symptoms.

The study showed more differences in children at 3.5 years old, whereas the differences appeared to level off at 4.5 years old. This may be due to the fact that children who have fewer verbal skills may act out more when experiencing CD, or any painful symptom. While there was no association in improved symptoms for those following a gluten-free diet, it is likely that the diet was not followed for long enough to be a factor.

While more studies need to be done, it is important that pediatricians and parents who notice some of the psychological symptoms (depression, anxiety, aggressive behavior, and sleep problems), coupled with gastrointestinal (GI) manifestation, look into whether CD could be the culprit. Because the disease damages the GI tract with each ingestion of gluten, the sooner a patient with CD starts a gluten-free diet, the better off they will be.

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