Coeliac disease in children is more common than you think. Up to one in one hundred people have coeliac disease.
The problem is, most of these don’t know it.
What signs would alert you to coeliac disease in children?
A 2013 study suggests the common symptoms of coeliac disease in children depend on the age of the child.
Coeliac disease in children younger than six is most likely to show as chronic diarrhoea and failure to thrive (that is, be small for age, short and skinny, with poor growth).
Kids older than six with coeliac disease are more likely to have the same symptoms an adult with coeliac disease would: “irritable bowel” symptoms. Abdominal pain and nausea are two of the key symptoms here. This is interesting, as nausea is not often thought of as a symptom of coeliac disease.
Abdominal pain was the most common symptom, being present in more than 50% of the sample of kids who were diagnosed with coeliac disease. It’s interesting to note than only just over a quarter of the kids had the symptom of diarrhoea, which people often mistakenly think of as the key symptom of coeliac disease. In fact, in the seven-to-thirteen age group, there was actually constipation in over 10%, and in the under-sixes, it was present in almost a quarter. This makes it clear that we should not forget about the possibility of coeliac disease in our paediatric patients with constipation!
Big tummies are also the other thing to look out for, especially in the under-sixes, one-third of whom had abdominal distension.
One final note was that in this group, approximately 13% of them were IgA deficient. Note well: this means that a blood screen for coeliac disease will produce a false negative in these kids. In other words, the (correct) diagnosis of coeliac disease will be missed! This is because the standard blood tests for coeliac disease (transglutaminase antibody and IgA antigliadin) both are IgA-based. They rely on normal amounts of IgA being present in the serum. If there is IgA deficiency, the individual will not test positive to coeliac disease on blood tests even when they have it.
Finally, coeliac disease is hard to diagnose in the under-fours. This is because until four years of age, coeliac serum testing is unreliable. So don’t assume that if your four-year old patient had a negative test for coeliac disease a year ago, she is clear of the disease. If you suspect it’s a possibility, make sure you refer appropriately for testing.