Coeliac disease and children: what you need to know

Coeliac disease often goes un-diagnosed, with around one person in every 100 thought to live with it in Ireland today.

Coeliac disease is classified in three different categories, namely:

• Silent coeliac disease - little to no symptoms but damage to the small intestine and stunted growth can result.
• Minor coeliac disease - a wide range of minor, and often intermittent, symptoms.
• Major coeliac disease - more severe symptoms caused by the malabsorption (not properly digesting) of food.

Signs & symptoms Children with gluten intolerance can experience a wide variety of symptoms and levels of discomfort. At the onset of the disease, children may be irritable, underweight or below average height. They may also have thin arms and legs and a bulging belly. Other tell-tale signs include:

• Chronic diarrhea or constipation
• Weight loss, despite having a good appetite
• Flatulence and intestinal colic
• Smelly, pale stools
• Stunted growth
• Fatigue, weakness and lack of energy
• Anaemia
• Frequent abdominal pains
• Abdominal swelling
• Muscle cramps
• Bone and joint pain
• Tingling sensation and numbness of the legs
• Painful blister rash on the skin (dermatitis herpetiformis)
• Defects in tooth enamel

In some instances, the disease is only detected when symptoms develop after a period of intense emotional stress, after surgery or after a physical injury or infection. Symptoms may also vary with age. Risk factors It is not known why some people develop coeliac disease, or why symptoms vary so dramatically between individuals. However, researchers have identified a number of risk factors that increase the chances of developing coeliac disease. 1. Family history If a close family member has coeliac disease, the risk of developing it is approximately ten percent, compared just one percent for those with no family history. The disease is strongly associated with a number of genetic mutations of a group of genes called HLA-DQ, which occur occur in about one-third of the population. 2. Environmental factors Common childhood stomach infections (such as rotavirus) and diet during early childhood have been linked to the development of coeliac disease. A number of studies have concluded that introducing gluten into an infant's diet before three months of age may significantly increase their risk. For that reason, experts recommended that you wait until your child is at least six months old before introducing gluten. Further research has identified an increased chance of babies developing coeliac disease if they are not being breastfed when gluten is introduced into the diet. 3. Health conditions A number of other health conditions and illnesses have been linked with coeliac disease including type 1 diabetes, ulcerative colitis, and epilepsy. However, it remains unclear how exactly these conditions are connected. Getting a diagnosis Although DIY blood tests are available, the Coeliac Society of Ireland recommend that you see your GP about such tests and don't attempt to diagnose your child yourself. It is important for children to be on a gluten containing diet prior to any form of testing to ensure an accurate result. Bear in mind that blood tests can be highly unreliable in children under the age of three. A biopsy procedure, called an upper gastro-intestinal endoscopy or oesophagastroduodenoscopy (OGD), can be carried out in an outpatient clinic. The painless procedure is quick (it usually takes around 15 minutes) and children are given a general anaesthetic. Treatment Coeliac disease is a life-long condition, with a gluten-free diet being the only available treatment. Although children will not 'grow out of it' as was often stated in the past, your child's symptoms will improve rapidly within a few weeks of becoming gluten-free. Support with a gluten-free lifestyle is essential to ensure a healthy, balanced and nutritionally adequate diet for your little one. The Irish Nutrition and Dietetic Institute can put you in touch with a fully qualified dietician who can advise you on the best steps to take to keep your child happy, healthy, and growing strong.