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Celiac Disease in children

Celiac disease in children usually manifests itself by the time the child is weaned. The child is perfectly normal till gluten is introduced in the diet. The first symptom of celiac disease in children is that they refuse feeds and fail to gain weight and, in some cases, height. The child becomes irritable, listless and pot-bellied (large, swollen abdomen) while the child's stools become large, pale or tan in color and offensive in smell and the child may develop diarrhea. Another observation indicating celiac disease in children is that the stools tend to float due to large amounts of gas (flatus) and fat trapped in the stool. The child may vomit occasionally but with the consumption of certain gluten-rich foods may exhibit projectile vomiting.Many paediatric experts recommend against introduction of gluten-containing cereals till the child is about six months old.

Celiac Disease in children

Celiac disease in children older than three years is more difficult to diagnose because the poor appetite, anemia and poor growth are symptoms common to many other childhood conditions. The child will also be irritable, have difficulty in concentrating and have a poor memory. During puberty, celiac disease in children seems diminished though this is a fallacy since the underlying biochemical abnormality still exists. This view is borne out by the fact that the symptoms of celiac disease in children reappear once the child is out of the stage of puberty. It is, therefore, very essential that the gluten-free diet that has been prescribed must be continued throughout.

While gluten remains in the diet, celiac disease in children continues to manifest itself through mood swings, depression, reduced learning and failure in following straightforward directions. While assessing celiac disease in children, it must be kept in  mind that the amount of intestinal tissue damage is the same for children and adults, but since children have a faster rate of cell replacement, the damage may be repaired to a certain extent.Gluten concentration is maximum in the upper portion of the small intestine (which lies just beyond the duodenum) and this is, thus, the place where maximum damage to the bowel occurs due to the immunological attack.

The only treatment till date is the lifelong avoidance of gluten and the child must be helped to accept that there will be foods that his /her friends will be able to eat but which are anathema for him/her. Celiac Disease in children is traumatic enough without giving the child a huge list of "what you can't eat" things. It is better and more beneficial for the child to have lists of "what you can eat" items on the refrigerator, at school and at restaurants. It also helps if the child is encouraged to have his/her own "snack drawer" or "snack box" where gluten-free snacks can be kept.

Celiac disease in children needs to be explained in as much detail as the child can understand and accept to enable the child to willingly inculcate the gluten-free diet.