Coeliac disease in children: symptoms and care

The specialist in Nutrition and Dietetics, Dr. Lama More, has a degree in Medicine and Surgery from the Complutense University of Madrid and specializes in Pediatrics and Child Care, Endocrinology and Nutrition. She currently works as a nutritionist at D-Médical and is Head of the Children’s Metabolism and Nutrition Unit at the ‘La Paz’ Children’s Hospital.

What care should be taken with a baby during the first feeding?

The ideal is to start feeding with breast milk, which should be maintained until six months of age as the only food. From then on, the diet should be diversified. Occasionally, another food can be included from the fifth month and never before the fourth month. It is advisable to administer small amounts of gluten while maintaining breast milk and should never start gluten intake before the fourth month or after the seventh month.

What are the symptoms of celiac disease or what changes in the baby to look for?

When the child eats gluten-containing foods, celiac disease generally presents with digestive symptoms: loss of appetite, sometimes with a change in the characteristics of the stools (they lose consistency, become soft, foul-smelling and may sometimes be shiny); chronic or intermittent diarrhea, chronic constipation, abdominal pain, iron deficiency anemia, poor weight gain or weight loss and hypogrowth, delayed puberty, amenorrhea and increased liver transaminases. Currently, celiac disease usually presents with few symptoms and therefore diagnosis is often delayed. But a change in appetite, delay in weight and height, changes in stool characteristics may raise suspicion. Some celiac children have mood changes, are more irritable or sad.

How is it diagnosed?

It is necessary that the child is taking gluten daily. As it is an immunological and hereditary disease, the diagnosis is made with the determination of intestinal anti-cell antibodies and anti-gliadin, which is a gluten protein. The genetic study is done by determining the histocompatibility antigens, which are genetically encoded proteins. There are many of them, but the ones that are of high risk of having celiac disease are two: HLA DQ2 and or DQ8 positive. Occasionally, the specialist may indicate the performance of intestinal biopsy and in this case, a severe villous atrophy (MARSH III) is required for diagnosis.

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What foods should be avoided in the infant diet of celiac patients?

Foods containing wheat, barley or rye flour (bread, cereals, pasta). it must be taken into account that many manufactured foods may contain gluten.

Is it necessary for the child to take any type of vitamin, since he/she is in the process of growth?

After the diagnosis it is necessary to take vitamins and iron for a period of time to replace the deficiencies caused by the disease. After this period they do not usually need more supplementation than a child of their age.

If a mother has celiac disease, can it be transmitted genetically to her children?

Yes it can, celiac disease is a family disease, if the child shares the risk haplotypes of his mother.

Is there a cure for celiac disease? What care and check-ups should a person with celiac disease follow?

Celiac disease is cured after the removal of gluten from the diet. You should be careful with manufactured foods that may contain small amounts of gluten. The gluten-free diet should be varied and balanced, taking care that the caloric intake is correct by choosing cereals that do not contain gluten (rice, corn, soybeans, millet, quinoa) to replace cereals that contain gluten. Coeliacs should be routinely monitored to ensure their adherence to the gluten-free diet (a high percentage drop out). Should be reviewed by your Gastroenterologist because you are at risk of associating other autoimmune diseases.