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When food enters the stomach, it’s broken down into tiny digestible particles, which then travel through the small intestine. The small intestine is lined with villi—tiny finger-like projections that absorb nutrients from the food passing through. In celiac disease, gluten damages the intestine and causes the villi to break down, leaving a smooth lining that can no longer absorb nutrients.
Celiac comes from the Greek word for “abdominal.”
While major complications are rare in children, if you suspect your child may have celiac disease, it’s important to get her checked out. If left untreated, the damage to the intestines may increase the risk of developing some cancers and/or autoimmune diseases.
Conditions associated with celiac disease include:
Yes—the parents and siblings of a child with celiac disease should be tested, regardless of whether they’re showing any symptoms, typical or atypical.
We need to wait for infants and small children to reach the age of 2 or 3 before they can be tested, since gluten exposure needs to trigger CD. Talk with your doctor about what makes the most sense for your family.
This is an area of ongoing research. There has been some evidence that introducing gluten while breast feeding (and not before 4 months of age) may be helpful, and a rotavirus vaccine may help to prevent an infection that might trigger celiac disease.
No, because it can be completely managed by diet.
While both celiac disease and food allergies refer to the body’s intolerance for certain substances, there are some important differences between celiac disease and food allergies:
You may be surprised by the variety of foods that your child can eat—and that’s what our registered dieticians will help you to focus on. A healthy gluten-free diet includes a variety of fresh fruits, vegetables, rice, quinoa, millet, buckwheat, meats, milk and milk products. There are also breads, crackers, pasta and desserts that are made from the allowed grains.
This varies for each child. Some children feel completely better after a few days on the gluten-free diet, and for others, it takes a bit longer. There may still be days when your child doesn’t feel well, and that’s normal. But if it persists, let your doctor know.
Generally speaking, no. As long as your child is feeling well enough to participate, physical activity is encouraged. In addition to the many other benefits of exercise, it can also help maintain bone density, which can be very helpful for children with celiac disease.
Unfortunately, gluten is very toxic to people who have celiac disease. As little as 50 mg per day of gluten can cause damage–that’s 1/100th of a piece of bread. That said, kids can’t live in a bubble, and there will be times when some gluten gets in.
Not yet, but there’s a significant lobby pushing to make this happen.
Yes. Gluten may also be found in:
Gluten-free versions of all of these things are available, and you can even find instructions for how to make gluten-free Play-Doh online!
For medications, make sure that you go to a pharmacy familiar with celiac disease—your child’s doctor will indicate on the prescriptions that there must be no substitutions, and all medicines must be gluten-free.
Make sure your child washes her hands after playing with Play-Doh. While protein can’t be absorbed through the skin, there’s a concern that it may get under her fingernails, and then into her mouth, if she puts her fingers there.
Nutritional labels have gotten better, but reading them is still a bit of an art and a science. A recent law requires that eight of the most common allergens be listed on the food label—this includes wheat, but not barley or rye.
Right now, “gluten-free” is generally used to indicate a supposedly harmless level of gluten, rather than a complete absence.
The U.S. Food and Drug Administration is considering a legal definition for “gluten-free,” and there’s a good chance that in the next year or two, it will declare a food to be “gluten-free” if it has an infinitesimal amount of gluten, perhaps along the lines of 20 parts per million.
The FDA could then test foods made anywhere—in gluten-free and non-gluten-free environments—to determine whether they’re safe for people who must avoid gluten.
Until then, we’re in a state of limbo, and have to use our best judgment. Keep in mind that this is disconcerting for many parents, and navigating the array of choices available gets much easier with time. Our registered dieticians will teach you how to interpret food labels, what to watch out for, and where to turn for more information.
Yes, the damage will heal, and your child’s intestine will look perfectly normal, so long as she avoids gluten.
Absolutely. Your child’s teachers and school nurse can be great allies in helping to protect your child’s health by encouraging her to follow her diet at school and providing alternative snacks or treats when appropriate.
One thing to remember is that for many teachers–and many people in general–“food intolerance” means something that causes an immediate, dramatic reaction, and requires emergency medical attention. They may need to be educated about your child’s condition.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”