Celiac disease (CD) is a chronic autoimmune condition where an immune reaction to gluten (a protein found in wheat, rye, and barley) damages the small intestine lining. This damage prevents the body from properly absorbing nutrients, leading to various health problems. An estimated one in every 100 children has the condition, and it can manifest at any time after gluten is introduced into their diet.
When Celiac Disease Typically Appears
For celiac disease to develop, a baby must possess specific genetic markers, primarily HLA-DQ2 or HLA-DQ8, and must have been exposed to gluten. While a large percentage of the population carries these genes, only about 3% of those people will go on to develop the condition. The disease usually becomes active several months after gluten-containing foods, such as cereals or formula, are introduced during the weaning process.
Symptoms can appear as early as six to nine months of age, though the timing varies significantly among children. Having a first-degree relative, such as a parent or sibling, with celiac disease increases a baby’s risk of developing the condition to about one in ten. Current evidence suggests no specific timing of gluten introduction offers protection against developing celiac disease.
Identifying Symptoms in Babies
Symptoms in infants and toddlers are often noticeable, particularly in the gastrointestinal tract. Common signs include chronic diarrhea, abdominal distention, and frequent vomiting. These digestive issues result from the small intestine’s damage, which hinders the proper breakdown of food.
Non-gastrointestinal symptoms are also common in this age group. Failure to thrive, defined as the inability to gain weight or grow at a healthy rate, is a frequent presentation of celiac disease in infants. Other signs include unexplained weight loss, chronic fatigue, and increased irritability. Nutrient malabsorption can also lead to iron-deficiency anemia, which is sometimes the only initial sign detected during a routine blood test.
The Diagnostic Process for Infants
The diagnostic process begins with blood screening for specific antibodies that the immune system produces in response to gluten. The primary tests measure the Tissue Transglutaminase IgA antibody (tTG-IgA) and the total IgA level to ensure the test is accurate. For very young children, typically under two years old, the Deamidated Gliadin IgA and IgG antibodies (DGP-IgA and DGP-IgG) may also be included in the screening panel.
The child must remain on a normal, gluten-containing diet throughout the blood testing phase. If gluten is removed before testing, the antibodies may disappear, leading to a false-negative result. If antibody tests are positive, a pediatric gastroenterologist typically confirms the diagnosis with an endoscopy and a small intestinal biopsy. The biopsy, considered the gold standard, allows the doctor to examine the small intestine villi for characteristic damage while the child is lightly sedated. In some pediatric cases, a biopsy may be avoided if tTG-IgA antibody levels are extremely high, allowing for a non-biopsy pathway to diagnosis.
Managing Celiac Disease in Early Childhood
Once a celiac disease diagnosis is confirmed, the sole treatment is a strict, lifelong adherence to a gluten-free diet (GFD). This dietary intervention allows the small intestine to heal, which is often visible within a few weeks, and enables the body to absorb nutrients necessary for growth and development.
Implementing a GFD for an infant or toddler presents unique challenges for parents. Reading ingredient labels on baby foods, cereals, and processed items is necessary to ensure they contain no wheat, barley, or rye. Preventing cross-contamination requires careful attention to food preparation surfaces, shared utensils, and household items like playdough. Dieticians help ensure the child receives adequate vitamins and minerals that may have been lost due to malabsorption or restricted by the new diet.