Pediatric Gastroenterology

Celiac Disease

Has your child been having stomach troubles lately? Does it seem that certain foods keep making your child sick? If so, it may not be just the occasional stomachache. It may be something more, such as celiac disease.

What is Celiac Disease?

Celiac disease involves an allergic reaction to gluten, which causes damage to your child's small intestines, more specifically to the villi, or finger-like projections, in your child's small intestines.

There is no cure for this condition, but it can certainly be managed by permanent diet changes. The only thing your child will need is a gluten-free diet. I know, it sounds like a boring way to live, but there is still enough variety of foods for children to enjoy themselves.

Symptoms of Celiac Disease

Symptoms of celiac disease can appear at any time after a child eats food that contains gluten. The symptoms can vary, and some may even have no symptoms. Once the food has been ingested, the damage has been done, so if you think your child has the disease it's important to contact a doctor immediately.

The symptoms can include:

• Chronic diarrhea or (rarely) constipation
• Irritability, Bloating, Gas and occasionally vomiting
• Decreased appetite and/or poor weight gain
• Growth/pubertal delay
• Anemia
• Fatigue
• Fractures/thin bones
• Decreased muscle mass in the limbs
• Damage to tooth enamel or failure of enamel formation
• A chronic itchy rash called dermatitis herpetiformis

Even if your child exhibits a majority of these symptoms, it is always best to take them into a pediatric gastroenterologist to be sure.

Diagnosis Process

Several tests are performed to confirm a gluten allergy. An anti-tissue transglutaminase antibody (tTG) and anti-endomysial (EMA) test are highly reliable, but accurate confirmation is done by an endoscopy with a biopsy.

This test involves a small, flexible tube being inserted through the mouth and going down through the stomach and into the small intestines to get tissue samples. If a diagnosis is made, a gluten-free diet is necessary to prevent further damage to the small intestines.

Treatment and How to Cope With This Disease

As said before, there is not a cure for this disease, but a gluten-free diet is an answer to the problem. Even though just changing your eating habits is all you need to do, it should be kept in mind that this is still a chronic disease, and should be treated as so.

Since the foods, you previously fed your child, such as cereal, pizza, bread, cake, and other foods containing gluten can no longer be ingested, extra care must be taken to avoid certain foods, restaurants, and even events such as parties and other outings.

At first, it can seem challenging and be restricting to your child but eventually, it will become easier. So please, remember to reach out to your dietitian or doctor if you need to join a celiac support group or go through therapy to deal with the depression, anxiety, or emotional stress that can come with the disease.

A Guide to a Gluten-Free Diet

Below are two fact sheets written in English and Spanish for planning a gluten-free diet for your child.

English Gluten-free Diet

Spanish Gluten-free Diet

To get a better grasp on the diet, let us first learn a little more about what gluten actually is.

What is gluten?

Gluten is the name for a protein found in wheat, rye, and barley. In flour, it forms the structure of the dough, sort of like the "glue", that holds it together, and it is also a leavening product. When those with CD consume these items, the lining of the small intestines is damaged, causing decreased nutrient absorption. This can lead to anemia, weight loss, lower bone density, and vitamin B12 deficiency.

What Foods Contain Gluten?

Grains such as wheat, rye, barley, and their derivatives (See Table 1) contain gluten. Foods such as bread, cereal, pasta, pizza, cakes, pies, cookies, and processed foods also contain gluten. It should be known that even though oats do not contain gluten, cross-contamination can occur during milling and processing, so check in with your dietitian.

Tips on Eating When Away from Home

Celiac disease should not keep your children from going to restaurants, so keep these tips in mind when selecting a restaurant.

• Check the restaurant's online menu before going to see what your child can eat. Some even have GF menus.
• Ask about how the restaurant prepares their gluten-free foods.
• Visit the restaurant before peak dining times.
• Do not be afraid to ask how things are prepared; cross-contamination can occur so be sure to check.
• Bring GF bread/crackers
• Above all, be informative and sweet, but not demanding!

Gluten May Not Be The Only Issue!

Being on a strict GF diet will make your child's symptoms better within a week, and they will completely disappear in 6-12 months. It is a good thing, but now you may no longer show symptoms if you accidentally ingest gluten or items that have no gluten but still irritate the GI tract. These items include:

• Acidic Foods: can cause acid reflux
• Sorbitol: In medications and dietetic candy, it can cause bloating, gas, cramping, and diarrhea.
• Guar Gum: gluten-free gum; It can cause bloating, gas, and abdominal pain.
• Lactose: will not be broken down before the intestines have completely healed due to low levels of lactase enzyme, which can cause gas, bloating, abdominal pain, and diarrhea
• Additional Food Intolerance: milk, soy, nuts, wheat, yeast, eggs, corn, and fructose
• Flax: increases the number of bowel movements

Also, remember that gluten-free is not always the healthiest alternative. Many foods out there are gluten-free but are not healthy. Eating a healthy diet is the most important aspect.

Again, the way to heal the damage from this disease may seem easy, but it can be hard for your child, or maybe even you! This does not mean that your child cannot live a full, productive, happy life, but it just has to be done in a cautious way. Things will get better, and eventually you and your child will be able to handle this disease better. Do not forget to use your resources, and take care.