Coeliac disease in children

Coeliac disease, also known as gluten intolerance, is a chronic autoimmune disease in which the ingestion of gluten damages the lining of the small intestine and prevents the body from absorbing nutrients properly. In children, the condition can manifest as poor well-being, reduced growth, or gastrointestinal symptoms such as diarrhea and abdominal pain, but some children have only mild or no visible signs. Coeliac disease is not contagious and is neither an allergy nor a dietary habit, but a lifelong condition that is treated with a gluten-free diet.

Coeliac disease is one of the most common chronic diseases in the Western world and is found in about 1 in 200 Danes, corresponding to approximately 0.5% of the population. The disease can occur as early as the first years of life, when the child begins to receive a gluten-containing diet, but it can also only cause symptoms later in childhood.

Are gluten allergy and coeliac disease in children the same thing?

"Gluten allergy" is a popular term that in most cases means celiac disease - it is not an official medical diagnosis. Celiac disease is an autoimmune disease in which the immune system attacks the intestinal mucosa when gluten is ingested. Confusingly, children also have food allergies (e.g. wheat allergy) and food intolerance, which can cause many of the same symptoms as celiac disease, but which are different conditions with a different background and treatment. Only a doctor can clarify which condition is involved.

What are the symptoms of coeliac disease in children?

The symptoms of coeliac disease in children vary significantly and often depend on their age. In infants and toddlers, common signs include general failure to thrive, difficulty gaining weight (or unexpected weight loss), and loose, frequent, foul-smelling stools. Affected children may also appear irritable and present with a bloated, distended abdomen.

In older children, poor height growth or delayed development are often the first signs that raise concern, frequently accompanied by abdominal pain, flatulence, and persistent fatigue. Unexplained iron deficiency anaemia is another common finding. However, some children display only mild, non-specific symptoms, or even none at all. In these cases, coeliac disease is often discovered through a routine blood test taken for another reason, or because the child is falling away from their expected growth curve.

Could poor growth in my child be due to coeliac disease?

Yes, delayed growth and a general failure to thrive are among the most common indicators of coeliac disease in children. This happens because the inflammation caused by the condition prevents the small intestine from properly absorbing vital nutrients from food. If a child is not following their expected growth curve and there is no other clear explanation, coeliac disease is one of the primary conditions a doctor will investigate, typically starting with a simple blood test.

Causes of coeliac disease in children

Celiac disease occurs when the immune system reacts abnormally to gluten – a protein found in wheat, rye and barley. The reaction damages the intestinal villi, the small finger-like projections in the small intestine that normally absorb nutrients from food.

The disease is strongly hereditary. Almost everyone with celiac disease has certain tissue types, called HLA-DQ2 or HLA-DQ8, which are present from birth and are a prerequisite for developing the disease. However, celiac disease itself only breaks out when the child begins to have gluten in their diet. If a close relative has celiac disease, the child is at increased risk and should have relevant antibodies measured if symptoms occur.

How are children tested for coeliac disease?

Suspicion of celiac disease is first clarified with blood tests, which measure antibodies against transglutaminase (TG2). These antibodies are elevated in the vast majority of children with active celiac disease. If the blood tests suggest celiac disease, the only examination that can confirm the disease with certainty is a tissue sample (biopsy) from the mucous membrane of the small intestine, taken during a telescopic examination (gastroscopy). It is always the doctor's assessment whether a gastroscopy is necessary in the individual case. If it is considered relevant, we refer to a specialized department that can carry out the examination in children.

It is important that the child continues to eat a gluten-containing diet until the investigation is complete - otherwise both blood tests and a possible biopsy may show normal results even though the child has celiac disease.

Treatment of coeliac disease in children

Celiac disease cannot be cured, but can be treated very effectively with a lifelong, completely gluten-free diet. When gluten is completely removed from the diet, the intestinal lining is given the opportunity to heal, and in the vast majority of children the condition normalizes completely – appetite, weight and growth often get back on track, and the symptoms disappear.

A gluten-free diet means avoiding all products containing wheat, rye and barley. Most children can tolerate certified gluten-free oats. At the beginning of treatment, some children may need iron or other mineral supplements if they have developed deficiencies.

Can children grow out of celiac disease?

Celiac disease is a lifelong condition that children do not outgrow. However, with a consistent gluten-free diet, children with celiac disease can have normal growth and development and live completely symptom-free. However, this requires that the diet be kept 100% gluten-free in the future – even small amounts of gluten can damage the intestine again over time, even if the child does not experience acute symptoms.

Complications of untreated coeliac disease in children

If coeliac disease in children is not treated, it can lead to complications over time. The most common are deficiency conditions such as iron, calcium and vitamin deficiencies, which can cause anemia and, in the long term, osteoporosis. Persistent, untreated celiac disease can also affect the child's growth if it is not corrected in time. It is therefore important to get the diagnosis early and then follow the child regularly to ensure that diet and growth develop as expected.

When should you see a doctor?

It may be relevant to contact your doctor if your child is not growing or gaining weight as expected, has repeated stomach pain, a change in bowel habits, unexplained fatigue or iron deficiency without another obvious cause. If you have a close relative with celiac disease, it may also be relevant to have a blood test done, even if the symptoms are mild.

Coeliac disease in children at Charlottenlund Private Hospital

The assessment is based on the child's symptoms and growth, and may include relevant blood tests and referral for further tests as needed. It is always the examining doctor who, in consultation with you, assesses the further course of action. If you are in doubt whether your child's symptoms may be due to coeliac disease, you are welcome to book an appointment online or contact us to find out more.

Experience and skills at Charlottenlund Private Hospital

At Charlottenlund Private Hospital, children with suspected coeliac disease are evaluated by pediatric specialists. The evaluation is based on the child's symptoms and growth, supplemented with relevant blood tests (antibodies against transglutaminase), and the child is referred for a tissue sample (biopsy) when deemed necessary. You will find an overview of all departments on our department page.

Sources:

- Danish Pediatric Society: Celiac disease – course description (2022).

- Weekly magazine for Doctors, Diagnostic challenges in celiac disease.