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Gluten intolerance or celiac disease in children

Children with gluten intolerance or celiac disease and stomach pain

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Facts and advice about gluten intolerance or celiac disease in children. Celiac disease is an autoimmune disease. It occurs when the immune system damages the intestinal mucosa after a person ingests gluten. Pediatricians do not usually use the terms gluten allergy, but there are similarities between celiac disease and an allergic disease.

Gluten is a protein found in wheat, rye and barley

The gluten protein is found in wheat, rye and barley. Gluten is responsible for the texture of baked goods. It contributes to the elasticity and the rise of the dough during fermentation. This is why gluten-free bread don’t have the same airy consistency as bread with gluten.

Gluten is not toxic or dangerous in itself. Only people with celiac disease need to avoid gluten. For anyone who does not have celiac disease, there is no reason to eat a gluten-free diet.

Celiac disease destroys the intestinal lining

The small intestine is the section of the gastrointestinal tract that absorbs the most nutrients. Absorption takes place on the surface of the intestinal wall. The intestinal wall is a fuzzy, carpet-like texture to optimize its surface area and thus maximize nutrient absorption. When a child with gluten intolerance eats gluten, the child’s immune system damages the intestinal mucosa. After a while, all the intestinal lining is gone. The intestinal mucosa becomes very flat, and full of white blood cells. When the intestinal lining is gone, this is called “villus atrophy”.

Normal small intestinal mucosa with the ‘fuzzy, carpet-like’ villi (top). The image at the bottom is villus atrophy. It is the damaged small intestinal mucosa associated with celiac disease.

Without intestinal lining, the child becomes malnourished

The function of the intestinal lining is maximize nutrient absorption. However, this cannot be achieved if the intestinal lining disappears. When the intestinal mucosa is full of white blood cells that break down the intestinal lining, nutrients is not absorbed efficiently.

A child, with celiac disease, who eats gluten will suffer from malnutrition. This will occur even if they eat a highly nutritious meal. The small intestine is too damaged to absorb nutrients, vitamins and minerals.

Malnutrition results in poor growth and often fatigue, apathy and depression in older children and adolescents. Iron deficiency is common. This can lead to anemia, pallor and fatigue. Vitamin D deficiency is also common. It can lead to, among other things, fatigue and depression and osteoporosis in the long term. Additionally, puberty does not always start as normal.

Read more about poor growth in children – investigate and interpret the growth curve

Read about iron deficiency in children

When the intestinal lining is gone, the ability to break down lactose in milk can also temporarily cease. A child who suddenly becomes very lactose intolerant should therefore take blood samples for gluten intolerance. When children with gluten intolerance eat a gluten-free diet, the lactose intolerance usually disappears.

Read more about lactose intolerance in babies here

Symptoms of gluten intolerance

Some children with gluten intolerance get a stomach ache. Others get diarrhea or constipation. Many grow poorly or don’t follow their growth curve and become tired and apathetic.

Blood tests for gluten intolerance

There is a really good blood test that is used to detect gluten intolerance. The sample taken is transglutaminase antibodies. If you take this sample to a hospital laboratory, the answer is almost certain.

Children who have no transglutaminase antibodies (and can produce the antibody IgA, which 98% can) are most likely not to have celiac disease. When the symptoms are severe and especially in a child who is not growing according to their growth curve, you have reason to speculate. You can proceed with a gastroscopy. A biopsy of the small intestinal mucosa can also be taken, but in most cases it is not necessary.

Children who have very high levels of transglutaminase antibodies are also more likely to have celiac disease. Take a blood test and a genetic test to make a diagnosis.

For the blood test to work, you must eat gluten daily. Therefore, if you have started a gluten-free diet and want to investigate celiac disease, you will need to start eating gluten again.

Gluten-free diet

In the event of a confirmed gluten intolerance, you need to eat a strict gluten-free diet. All symptoms will disappear, the transglutaminase antibodies disappear and the intestinal lining grows back to its fuzzy-like structure again. In the event of a confirmed gluten intolerance, you therefore need to be instructed by a dietitian on how to eat a strict gluten-free diet.

Read more:

Poor growth in children – investigate and interpret the growth curve

Read about iron deficiency in children

Baby poo – what is normal? Green poo or slimy – what does that mean?

Stomach pain in children – is it the appendix?

Lactose intolerance in children – symptoms, tests, treatment

Milk protein allergies in babies and milk-free alternatives for infants

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