Coeliac disease in children

What is coeliac disease?

Coeliac disease is an autoimmune condition where the lining of the small bowel is damaged. This happens because a common protein in food called gluten causes the gut lining to become inflamed and flatten the villi — tiny, finger-like projections that line the bowel. Foods that contain gluten include wheat, rye, barley and oats.

Villi are responsible for absorbing the nutrients found in food. Symptoms of coeliac disease usually relate to changes in the surface of the gut and poor absorption of energy, vitamins and minerals.

How common is coeliac disease in children?

Rarely, coeliac disease occurs before 12 months of age, but it can affect children of any age once they start eating solid foods that contain gluten.

It is estimated that coeliac disease affects around 1 in every 100 people. This condition is more common in people of European descent, but it can affect anybody.

What are the symptoms of coeliac disease?

Coeliac disease can cause several symptoms, although some children have few or no symptoms at all. For children who experience chronic symptoms, the impact can be significant.

Common symptoms include:

• gastrointestinal symptoms including abdominal bloating, wind and nausea
• constipation or diarrhoea
• vomiting
• mouth sores or ulcers
• irritability
• tiredness
• joint and bone pain
• unexplained weight loss
• slow weight gain
• unexplained fever
• bulky, foul-smelling poo
• vitamin and mineral deficiencies
• anaemia due to iron deficiency

What are the causes and risk factors of coeliac disease?

It is thought that both genetics and environmental factors may lead to coeliac disease. Close relatives of someone with coeliac disease have an increased risk, estimated at up to 10%, of developing it themselves. More than half of the Australian population have the main coeliac risk genes.

It’s not clearly understood why some people who are genetically susceptible develop coeliac disease. However, it’s likely that a range of environmental factors may play a role.

How is coeliac disease diagnosed?

Blood tests can screen for antibody levels, but confirming the diagnosis is generally done by taking a biopsy of the small bowel. Blood tests are not as precise as examining a tissue sample. Before testing is done, the general advice is for the child to keep eating gluten for at least 6 weeks beforehand. Removing gluten from the diet before testing can return a false negative result on blood tests.

Tissue samples are taken via a simple procedure called a gastroscopy (endoscopy). Tiny samples of the lining of the small bowel are taken and collected for examination under a microscope. The pathologist who examines the tissue sample will be able to identify if there is villous atrophy (flattening of the villi) in the bowel lining sample. This will confirm the diagnosis of coeliac disease.

Gene testing for coeliac disease can also be carried out. However, even if the genes for coeliac disease are found, this does not mean the person has, or will develop, coeliac disease.

How is coeliac disease treated?

There is no specific treatment or medication for coeliac disease. Once the diagnosis is confirmed, it is important to exclude any dietary gluten by starting the child on a gluten-free diet (GFD). When the gut has had a chance to heal and there is no further damage to the gut lining, most symptoms disappear. Depending on the individual and the extent of their gut damage, symptoms can take a while to resolve.

Gluten-free foods

Once your child has been diagnosed with coeliac disease, you will be advised to put them on a gluten-free diet.

Common foods that include gluten are:

• bread
• breakfast cereals, particularly those which contain oats, wheat and barley
• biscuits, cakes and muffins that contain wheat flour
• pasta and wheat-based noodles
• couscous, semolina and burghul

Gluten can also be in:

• sauces
• dressings
• smallgoods
• custard powder and icing sugar
• malted additives for milk drinks
• soups, stocks and gravies
• yeast extracts
• some medications

It is useful for parents to read food labels and ingredient lists. Some foods are easier than others to identify as containing gluten.

In Australia, there are mandatory labelling standards that state that all ingredients and food additives derived from wheat, rye, barley or oats must be declared in a food product’s ingredient list.

It is also important to avoid cross contamination with food that has gluten. When preparing, cooking and serving food, keep gluten-free food and food with gluten separate from each other. Wash your hands well after handling food with gluten.

Can coeliac disease cause other complications?

Left untreated, coeliac disease can cause nutritional deficiencies, including chronic iron-deficiency anaemia.

Children with coeliac disease can also experience slow weight gain and growth problems, delayed puberty, chronic fatigue, osteoporosis and an increased risk of (additional) autoimmune diseases.

Left untreated, coeliac disease can also impact school performance.

When should I see my doctor?

Take your child to see your GP if you suspect they may have coeliac disease. It is important that you don’t restrict their diet before you see a healthcare professional and that your child is tested. Children need a wide range of nutritious foods to grow and thrive.

Resources and support

• Speak with your GP about what support they can provide.
• Ask your GP for a referral to a paediatrician.
• It is often useful to obtain a referral to a paediatric dietitian who can provide specific dietary advise about gluten-free foods. Dietitians and paediatricians work in private practices or within large public children’s hospitals.
• Check Coeliac Australia for more information and support.