Celiac disease is an autoimmune condition where the immune system reacts abnormally to gluten, a protein found in wheat, barley, and rye. This reaction damages the small intestine’s villi, which are finger-like projections responsible for nutrient absorption. Over time, this damage can lead to various health issues due to nutrient malabsorption.
Understanding Genetic Inheritance
Celiac disease has a strong genetic component. Inheriting specific genes does not guarantee the condition’s development; it is a multifactorial disorder where multiple genes interact with environmental factors. The genes most associated with celiac disease are HLA-DQ2 and HLA-DQ8. Over 95% of individuals with celiac disease possess one or both of these genetic markers.
While strongly associated, HLA-DQ2 or HLA-DQ8 genes are necessary but not sufficient for celiac disease to develop. Approximately 20-30% of the general population carries these genes without developing the condition. If one parent has celiac disease, a child’s risk of developing it is estimated at 5-15%, or about 1 in 10. This risk increases if both parents have the condition, though specific percentages can vary.
Environmental factors also trigger celiac disease in genetically predisposed individuals. These can include gastrointestinal infections, severe emotional stress, or surgery. The timing and amount of gluten introduction in an infant’s diet, while theorized to contribute, do not definitively increase the risk for genetically predisposed individuals.
Recognizing Symptoms and Diagnosis in Children
Celiac disease symptoms vary widely in children. In infants and toddlers, common digestive symptoms include chronic diarrhea, abdominal distention, bloating, vomiting, and irritability. Poor growth, weight loss, or failure to thrive are also frequent indicators due to nutrient malabsorption.
Older children and teenagers may experience abdominal pain, constipation, or trouble gaining weight. Beyond digestive issues, celiac disease can present with non-digestive symptoms such as iron-deficiency anemia, dental enamel defects, and dermatitis herpetiformis. Other signs might include chronic fatigue, headaches, delayed puberty, or recurrent mouth sores. Some children with celiac disease may have very mild symptoms or no obvious symptoms.
Diagnosis typically begins with blood tests for celiac-specific antibodies, such as IgA tissue transglutaminase (tTG-IgA) and deamidated gliadin peptide (DGP-IgG). The child must continue consuming gluten regularly before and during these tests for accurate results. If blood tests are positive, an endoscopy with a small bowel biopsy usually confirms the diagnosis by examining for intestinal lining damage. In some cases, a biopsy may not be necessary for diagnosis in children if specific high antibody levels are met and confirmed by a pediatric gastroenterologist.
Managing Celiac Disease in Children
Once diagnosed, the primary and lifelong treatment for celiac disease in a child involves strict adherence to a gluten-free diet. This means completely avoiding all foods containing wheat, barley, and rye. Even small amounts of gluten, such as crumbs, can trigger an immune response and cause intestinal damage.
Families must learn to identify hidden gluten sources in food products and prevent cross-contamination during food preparation. A registered dietitian specializing in celiac disease can provide guidance on dietary changes, ensuring the child receives adequate nutrition while maintaining a strict gluten-free diet. Symptoms typically improve and intestinal healing begins once the gluten-free diet is consistently followed. Regular follow-ups with healthcare providers monitor progress and address ongoing nutritional needs.
Considerations for Parents with Celiac Disease
Given celiac disease’s genetic nature, first-degree relatives (parents, siblings, and children) of an affected individual should consider testing. Screening helps identify affected family members, even those without symptoms. Early diagnosis can prevent long-term complications like nutritional deficiencies or other autoimmune conditions.
For mothers with celiac disease, maintaining a strict gluten-free diet during pregnancy is important for their health and nutritional status. Studies suggest a mother’s gluten intake during pregnancy or breastfeeding does not influence her child’s risk of developing celiac disease. However, untreated celiac disease in pregnant mothers has been associated with an increased risk of certain birth defects. Regular medical follow-ups are important for both parents with celiac disease and any affected children to ensure ongoing health and proper management.