Around one in 100 people in the UK have coeliac disease. This means they are sensitive to the protein gluten which is found in wheat, rye, and barley. Some are also sensitive to oats.
The condition is not the same as food allergy or intolerance. It is an auto-immune response, which means that a child’s own immune system begins to attack their body’s tissues when gluten is detected.
The result can be uncomfortable symptoms that can make life tough for a child.
Impact of coeliac disease
There isn’t any cure – once diagnosed, coeliac disease is a life-long condition that a person does not grow out of.
With the right help and support, families can make changes to a child’s diet to minimise the risk of symptoms and prevent complications.
What is coeliac disease?
When a child eats food containing gluten, the body reacts as though it is harmful and antibodies are produced.
This reaction causes damage to the lining of the small intestine (gut) and can also affect other parts of the body.
In turn, the damage prevents the body from absorbing essential nutrients from carbohydrates, fat, protein, vitamins and minerals.
This can lead to a number of symptoms including:
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diarrhoea
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constipation
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abdominal pain
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weight loss
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malnutrition
Who is most likely to get it?
Coeliac disease does runs in families. Research shows that a child has a one in 10 chance of developing coeliac disease if a close family member has it.
It can develop at any age. Sometimes, an infant may show signs of coeliac disease after weaning but it can develop in later childhood (or even adulthood) too.
What are the signs and symptoms?
These vary – some children are mildly affected, while others experience more severe symptoms that can make life tough.
Signs and symptoms can include:
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diarrhoea or constipation
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nausea
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bloating and excessive wind
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itchy rash
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tiredness and headaches
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weight loss (but not always)
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abdominal pain
As a result of food being poorly absorbed, a child’s growth and weight can be affected.
Health impact
Anaemia can be a problem because a child isn’t able to absorb enough dietary iron from their food.
Also, lack of calcium can be a problem as not enough will be absorbed from an early age. This can lead to osteoporosis in later life.
Other symptoms in young children include irritability and muscle wasting in the arms and legs.
Symptoms vary in older children, but can include poor growth and frequent mouth ulcers.
How is it diagnosed?
Your GP will look at your child’s symptoms and take a blood test. This checks for a specific type of antibody made by the body in response to eating gluten.
It’s important not to omit gluten from your child’s diet before the test otherwise these antibodies will be difficult to detect. Stay on a normal gluten containing diet before all investigations are carried out.
Paediatric gastroenterologist
The GP will then refer your child to a paediatric gastroenterologist (doctor specialising in children’s gut problems).
To confirm the diagnosis, a child will need a gut biopsy. This involves passing an endoscope (a thin flexible tube with a light at the end) through the mouth, into the stomach, then into the small intestine.
The doctor can look down the tube, see the gut lining clearly and collect small samples of gut lining (biopsies). These samples are examined in the laboratory to check for abnormalities consistent with coeliac disease.
In young children, this test is usually carried out under general anaesthetic.
What does treatment involve?
Unfortunately there isn’t any treatment other than avoiding the problem food – gluten.
Gluten is in lots of different foods including:
Some children need to cut oats out of their diet too.
Gluten-free foods
Your child will be referred to a specialist dietitian who can discuss the gluten-free diet with you in detail, and help you plan healthy meals that are suitable.
Lots of foods are naturally gluten free and your child will able to eat these freely. These include:
Alternative foods
Gluten-containing foods are considered staples in most diets so alternatives are important. Lots of products made from suitable gluten-free flours are available on prescription for your child.
Also most supermarkets now offer ‘free-from’ ranges of foods, some of which will be gluten free. The dietitian will be able to advise you on these products and how to get hold of them.
Once your child has been gluten-free for a while, their body will begin absorbing the nutrients that they need from their diet again.
It can take the small intestine around three to six months to recover fully. Your child should start feeling better within a few weeks but this can vary.
Your child will need to follow a gluten-free diet for life.
What’s the outlook?
There is no cure for coeliac disease and it is not a condition that a child grows out of.
Your child will need regular check-ups with a dietitian, paediatrician or GP to make sure they are growing well, and to make sure your child is not developing other conditions that can be associated with coeliac disease, such as osteoporosis.
You will need to see a dietitian regularly too to review your child’s diet, make sure it is still gluten-free, check your child is not avoiding foods they don’t need to and ensure they are growing adequately.
