Gluten Intolerance in Children: Symptoms,
Causes, Diagnosis and More

Gluten intolerance (also called celiac disease) is an autoimmune disorder caused by intolerance to gluten. Gluten is a protein found in wheat, rye, barley, and other grains derived from them.

In kids with gluten intolerance, gluten damages the villi, the finger-like projections in the small intestine responsible for absorbing nutrients from food. If the villi are damaged, the body cannot absorb nutrients the body needs to grow. When that happens, a child can become malnourished.

Gluten intolerance, according to the website KidsHealth.org, can lead to a wide variety of symptoms in different people. Infants may fail to gain weight and height as expected. In older kids, the condition can cause diarrhea, abdominal pain and bloating, weight loss, fatigue, or painful skin rashes. Others who have gluten intolerance experience no symptoms at all.

Doctors do not know for sure what triggers the immune system to react to gluten in people who have gluten intolerance. There is no cure, but if your child is diagnosed with gluten intolerance, there are ways to remedy the symptoms and prevent any damage to the intestines.

SYMPTOMS OF GLUTEN INTOLERANCE

Symptoms of gluten intolerance can occur at any time in a child's life. Some kids experience symptoms the first time they are exposed to gluten, while others develop symptoms later in life after consuming gluten products without a problem for years.

A first sign that an infant might have gluten intolerance can occur shortly after the introduction to solid foods such as cereals. An infant who has started consuming foods that contain gluten might have diarrhea and stomach pains, and stop gaining weight at a healthy pace. Skin rashes might also appear, especially around the elbows, buttocks, and knees. Over time, the child might develop anemia and mouth sores, and become withdrawn or irritable.

WHAT CAUSES GLUTEN INTOLERANCE?

The causes of gluten intolerance are unknown. Gluten intolerance tends to run in families, so if there is a family history of gluten intolerance, your child may have a higher risk of developing it. If one child is diagnosed with gluten intolerance, his or her siblings, parents, and grandparents should be tested too, as they may have the disease but be symptom free. Gluten intolerance that goes undiagnosed in adults for a long time can lead to serious health problems.

DIAGNOSING GLUTEN INTOLERANCE

Diagnosing gluten intolerance usually begins with a simple blood test that measures the level of antibodies to gluten and other proteins in the lining of the intestine. If high levels of these antibodies are found, the doctor will likely order a biopsy of the small intestine and send it to a laboratory for testing.

Doctors take this tissue sample by inserting a long, thin tube called an endoscope through the mouth and stomach into the small intestine. A child is usually moderately sedated or put to sleep under general anesthesia for the procedure.

DIETARY CHANGES FOR GLUTEN INTOLERANCE

If gluten intolerance is diagnosed, the doctor will give you guidance on which foods your child can eat and which to avoid. Because these changes will greatly affect your family's everyday life and your child's diet, the doctor may suggest that you meet with a nutritionist for additional advice.

Wheat, barley, rye, and related grains should be eliminated from the child's diet. In general, if your child has celiac disease, it is wise to stay away from foods that contain any gluten-related ingredients.

It is generally safe for a child with gluten intolerance to eat oats, as long as the oats come from an uncontaminated source. That means that the oats have been processed in a mill that does not process grains that contain gluten on the same equipment. The label on the package of oats should clearly state if that is the case.

To avoid these gluten products, and prevent triggering your child's symptoms, it is important to carefully read the labels of all foods before you buy them or let your child consume them. Help your child learn to do it too. When in doubt, the safest thing to do is to assume the product contains gluten and leave it out.

EATING OUT

People with gluten intolerance are not limited to eating at home. With experience and knowledge, you will be able to figure out which dishes at restaurants or friends' homes contain gluten. Some restaurants even offer gluten-free dishes on their menus. Sometimes, no matter how well prepared you are, you might not be able to find out if a particular food is gluten free. When in doubt, order something else for your child to eat!

In restaurants, tell the server or the kitchen staff about your child's condition and make sure that they know it is important that your child's food do not contain any gluten or related ingredients.

TIPS TO REMEMBER WHEN CHOOSING FOOD:

1. Start with the foods your child can eat.

   Foods and ingredients that someone with celiac disease can eat and use in cooking include:

   • Foods made with the flours of corn,
   • Rice,
   • Buckwheat,
   • Sorghum,
   • Arrowroot,
   • Chickpeas,
   • Tapioca,
   • Potato (provided other ingredients in your recipe do not contain gluten).
   • All plain meats,
   • Fish,
   • Chicken,
   • Nuts,
   • Seeds,
   • Oils,
   • Milk,
   • Cheese,
   • Eggs,
   • Fruits,
   • Vegetables.
   
   
2. Be on the lookout for possible cross-contamination. Even when eating or preparing foods that are gluten free, if these foods come into contact with foods that contain gluten, there is a risk of cross-contamination. For example, crumbs from regular wheat bread can find their way into jams, spreads, or condiments if people are not careful to use a fresh knife or utensil each time.

Keeping condiments in squeezable bottles and using separate jams and spreads for people with gluten intolerance is a great idea. It is also wise to keep a separate toaster for gluten-free bread.

If you bake with products that contain gluten, thoroughly clean appliances, utensils, and work surfaces before preparing gluten-free products. Remember to wash your hands thoroughly and often when you are cooking and preparing food.

Most grocery stores carry some gluten-free bread, cereal, baking mixes, cookies, crackers, and other products. Health food stores and natural food markets may have wider selections of these foods. It is not a good idea to use gluten-free products from bulk food bins because of the risk of cross-contamination.

Even if you take precautions, chances are your child may accidentally ingest gluten at some point. That is OK! A single small amount of gluten ingestion may cause mild inflammation in the gut but probably will not cause any immediate symptoms. Normally, the lining of the small intestine completely renews itself every 3–4 days, so after a single incident the damaged cells are quickly replaced with new ones.

HELPING YOUR CHILD DEAL WITH CELIAC DISEASE

If your child has gluten intolerance, it is important to educate the other adults in your child's life — teachers, school nurses, babysitters, and friends' parents — about the condition, and to explain the importance of keeping foods with gluten away from your child.

Teach older kids not to accept foods they are offered unless they are from someone who is known to be attentive about ensuring the food is gluten free.

It may be difficult for your child to adapt to a gluten-free diet and, at first, it may be challenging for you to make all the right accommodations. Over time, you and your child will get to know which foods are safe and which are off-limits, making it easier to find meals, snacks, and ingredients that won't cause any symptoms.

Many kids with symptoms who are diagnosed with gluten intolerance feel better quickly after gluten is eliminated from their diet and make a smooth transition to gluten-free eating.

When symptoms are mild or absent, kids may have a more difficult time with dietary changes. In such cases, strong family support is especially important.