About Celiac Disease in Children
The causes of celiac disease in children are not fully understood, but there are several factors that contribute to its development. Here are the potential causes:
- Genetic predisposition: Having certain genes, specifically the human leukocyte antigen (HLA) DQ2 and DQ8 genes, increases the risk of developing CD.
- Environmental triggers: Infections, such as viral or bacterial infections early in life, have been suggested as potential triggers for CD development in genetically predisposed children.
Non-modifiable risk factors for CD in children cannot be changed or controlled. These include:
- Sex assigned at birth: Celiac disease can affect both males and females. However, studies have shown that females are more likely to be diagnosed with the condition compared to males.
- Family history: Having a first-degree relative with CD, such as a parent or sibling, increases the risk of developing the disease.
- Genetic factors: Carrying the HLA-DQ2 or HLA-DQ8 genes also increases the risk.
- Race or ethnicity: Although celiac disease can affect people of any race or ethnicity, it is more commonly diagnosed in individuals of European descent. However, it is important to remember that celiac disease can occur in people from all racial and ethnic backgrounds.
Modifiable risk factors for CD in children can be influenced or changed. These include:
- Timing of gluten introduction: Introducing gluten into a baby's diet before 4 months or after 7 months of age may increase the risk.
- Breastfeeding: Some studies suggest that breastfeeding at the time of gluten introduction may reduce the risk of developing CD. It is important to know that there are also studies that suggest that breastfeeding does not play a significant role in the development of CD.
It's important to note that while these factors are associated with an increased risk of CD, they do not guarantee its development. If you suspect your child may have CD or have concerns about their risk factors, it's best to consult with a healthcare professional for further evaluation and guidance.
The most common early symptoms of celiac disease in children include:
- Abdominal pain and/or bloating
- Vomiting
- Chronic diarrhea or constipation
- Irritability
- Reduced appetite
As the disease progresses, additional symptoms may occur, such as:
- Unintentional weight loss or difficulty gaining weight
- Malnutrition
- Delayed puberty
- Stunted growth
- Fatigue
- Bone or joint pain
- Frequent headaches or migraines
- Skin rashes
- Mouth sores
- Depression and anxiety
If you suspect that your child may have celiac disease, it's best to talk with their pediatrician about getting tested to determine whether treatment is necessary.
To diagnose celiac disease in children, doctors commonly perform the following examinations, tests, and procedures:
- History and Physical examination: A doctor will conduct a physical examination and review the child's medical and nutrition history.
- Blood tests: Blood tests can detect the presence of specific antibodies associated with Celiac Disease, such as anti-tissue transglutaminase (tTGA) and anti-endomysial antibodies (EMA).
- Genetic tests: Genetic tests can determine the presence or absence of specific genes associated with Celiac Disease.
- Intestinal biopsy: A biopsy of the small intestine is the most accurate method to diagnose Celiac Disease. During an endoscopy, a thin tube with a camera is inserted through the mouth to examine the small intestine and take tissue samples for analysis.
To determine the stage or severity of celiac disease in children, additional examinations and tests may include:
- Follow-up blood tests: These can monitor antibody levels and assess response to treatment.
- Nutritional assessment: This evaluates any nutritional deficiencies resulting from malabsorption caused by celiac disease.
- Bone density scan: Osteoporosis or low bone density can be assessed using a bone density scan.
- Serological markers: These markers can help track disease activity and response to treatment.
Remember, each child's situation is unique, so it's important to consult with a healthcare professional for personalized advice.
The goals of treatment for celiac disease in children are:
- Eliminate Gluten: The primary treatment for CD is a lifelong adherence to a gluten-free diet (GFD). This involves avoiding foods that contain gluten, such as wheat, barley, and rye. The GFD aims to reduce symptoms, promote intestinal healing, and prevent long-term complications.
- Education: In-person, gluten-free diet education provided by a registered dietitian with expertise in CD is crucial. Education helps children and their families understand which foods to avoid, how to read food labels, and how to safely prepare gluten-free meals. It increases knowledge about CD and improves adherence to the GFD.
- Enzymatic Treatment: Supportive Care: Supportive care may include addressing nutritional deficiencies that can occur due to a poorly implemented GFD. Regular follow-up visits with a dietician can help monitor nutritional status and provide guidance on achieving a balanced diet.
It is important to note that there are currently no medications specifically approved for treating CD in children. There is ongoing research on enzymatic treatments that aim to improve the quality of life and reduce symptoms in CD patients who inadvertently consume gluten. These treatments work by fragmenting gluten in the stomach and small intestine.
The mainstay of treatment remains strict adherence to a gluten-free diet. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.