Toddlers can develop celiac disease, an autoimmune condition that affects their small intestine. Understanding this possibility is a crucial first step toward proper care and management.
What Celiac Disease Is
Celiac disease is an autoimmune disorder where consuming gluten, a protein found in wheat, barley, and rye, triggers an immune response in the small intestine. This response attacks the small, finger-like projections lining the small intestine, called villi. Damage to these villi impairs the intestine’s ability to absorb nutrients from food, leading to various health issues. The condition is hereditary; individuals must have specific genes, primarily HLA-DQ2 or HLA-DQ8, to develop it, though not everyone with these genes will develop the disease.
Signs in Toddlers
Toddlers with celiac disease can present with a wide range of signs. Digestive symptoms are common and can include chronic diarrhea, frequently pale and foul-smelling stools, constipation, abdominal pain, bloating, and vomiting. Non-digestive signs are also observed, including poor weight gain, delayed growth or short stature, and irritability. Other possible indicators include dental enamel defects, anemia, and chronic fatigue. Symptoms might appear any time after gluten-containing foods are introduced into the diet, typically after six to nine months of age.
How Celiac Disease is Diagnosed
Blood Tests
Diagnosis involves blood tests for specific antibodies. The primary tests include tissue transglutaminase IgA (tTG-IgA) and endomysial antibody (EMA-IgA). For accurate results, the child must continue consuming gluten during testing, as premature removal can yield false negatives. For children under two years old, deamidated gliadin peptide (DGP) IgA and IgG antibodies may also be included, as tTG-IgA can be less sensitive in this age group.
Confirmatory Biopsy
If blood tests are positive, an intestinal biopsy, usually performed via endoscopy, confirms the diagnosis. During this procedure, small tissue samples are taken from the small intestine to examine for villous atrophy and other characteristic changes.
Genetic Testing
Genetic testing for HLA-DQ2 and HLA-DQ8 genes is also available. A negative result for these genes rules out celiac disease, as most individuals with the condition carry one or both. However, a positive genetic test alone is not sufficient for diagnosis, as many people carry these genes without developing the disease. A pediatric gastroenterologist guides the diagnostic process.
Life with Celiac Disease
Managing celiac disease in toddlers involves a lifelong gluten-free diet, meaning avoiding all foods containing wheat, barley, and rye. Reading food labels is essential, as gluten can be present in many unexpected products, including some processed foods, sauces, and even non-food items like certain glues or playdough. Preventing cross-contamination at home is important, involving separate cooking utensils, cutting boards, and toasters for gluten-free items. A registered dietitian specializing in celiac disease can provide guidance on maintaining a nutritionally balanced gluten-free diet to ensure the toddler receives all necessary nutrients for growth and development. Regular follow-up with healthcare providers helps monitor the child’s response to the diet, ensuring the small intestine heals and any nutritional deficiencies are addressed.