The Child with Celiac Disease: What Every Parent Should Know Thomas J. Sferra, MD, a pediatric gastroenterologist and Chief of the Division of Pediatric Gastroenterology, Hepatology & Nutrition at University Hospitals Rainbow Babies & Children’s Hospital, says that celiac disease – a disorder of the small intestine caused by an inappropriate immune response triggered by gluten, a protein found in wheat, rye and barley – is more common in children than most people realize. “Celiac disease is an autoimmune disorder, not an allergic reaction to wheat products. A wheat allergy is a different entity,” he says. Children with celiac disease can develop a wide variety of symptoms when exposed to gluten. These symptoms commonly include decreased appetite, abdominal pain, diarrhea, bloating, and weight loss or poor growth. Rashes on the extremities, dental enamel changes, anemia, osteoporosis (bone thinning), and elevated liver enzymes, also, might occur in those with this disease. Symptoms and signs of celiac disease typically present between 16 to 24 months of age, after a child is exposed to cereal, bread, pasta and other foods containing gluten. However, the condition may surface at any age. The risk of developing celiac disease is increased in individuals with a close relative (e.g., sibling or parent) affected by this disease. Also, children with type 1 diabetes, autoimmune thyroid disease, Down syndrome, Turner syndrome, Williams syndrome and IgA deficiency have an increased susceptibility to celiac disease. “Any child who falls into one of these categories or has symptoms associated with celiac disease should be evaluated for this disorder,” says Dr. Sferra. If a parent or guardian suspects his or her child has celiac disease, the family’s primary care physician What is gluten? Gluten is a type of protein found in wheat, barley and rye. Most baked goods like breads and pastries contain gluten, because it gives elasticity to dough and makes it appear stretchy. Other foods, including cereals, noodles and pastas, also contain gluten. Although gluten is typically listed on packaging labels, consumers may not know that the ingredient is sometimes used in medications, puddings and beverages. Fortunately, gluten-free product alternatives are available at most grocery stores for patients who are unable to eat specific cereal grains. or pediatrician can initiate an evaluation. If necessary, the child will be referred to a pediatric gastroenterologist for further testing. Dr. Sferra explains that patients are evaluated initially through a simple blood test. If the test is positive, a diagnosis is confirmed with a small bowel biopsy. “Once the diagnosis is established, treatment is not a medication, but a gluten-free diet.” Children and their families work with a pediatric dietitian experienced in counseling young patients on staying healthy through appropriate food choices. “Many foods children like contain gluten” he says. “Compliance with the gluten-free diet is difficult, but patients who follow it lead a normal, active life.” (continued on other side) Dr. Sferra sees an increase in the number of patients diagnosed with celiac disease and attributes the higher numbers to proactive screening in young patients who may display no overt symptoms, but have a first-degree relative with the disease. He says the triggers for celiac disease have not yet been identified. However, infection or other environmental factors may play a role in the onset of the condition. “There is definitely a genetic component, but it is unknown as to why some children develop the disease, and others do not.” Dr. Sferra stresses the importance of increasing celiac disease awareness. “If it is left untreated, celiac disease can lead to lifelong symptoms and nutritional deficiencies.” Thomas J. Sferra, MD Martin and Betty Rosskamm Chair in Pediatric Gastroenterology UH Rainbow Babies & Children’s Hospital Associate Professor Case Western Reserve University School of Medicine The UH Rainbow Babies & Children’s Hospital pediatric gastroenterologists see patients at the following locations: UH Rainbow Babies & Children’s Hospital 11100 Euclid Avenue Cleveland, Ohio 44106 UH Landerbrook Health Center 5850 Landerbrook Drive Mayfield Heights, Ohio 44124 UH Medina Health Center 4001 Carrick Drive Medina, Ohio 44256 UH Westlake Health Center 960 Clague Road Westlake, Ohio 44145 Firelands Regional Medical Center 1912 Hayes Avenue Sandusky, Ohio 44870 Call 216-UH4-KIDS To make an appointment with a UH Rainbow Babies & Children’s Hospital pediatric gastroenterologist, call 216-844-5437 or visit RainbowBabies.org. There’s only one Rainbow. © 2012 University Hospitals RBC 00606