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Celiac Child

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The Celiac Child and Growing
Dr.  Robert Issenman

Celiac Disease affects people of all ages.  However, the effects of the disease on children are particularly dramatic. 

Similarly, the effect of a gluten free diet on a celiac child produces one of the most miraculous responses seen in medicine.

Signs and symptoms of Celiac Disease in infants and children are irritability, loss of appetite, weight loss, growth failure, chronic diarrhea, rarely chronic constipation, fine hair, luxuriant eyelashes, decreased sub-cutaneous tissue, loss of muscle mass, protuberant abdomen, gluteal wasting.

What's special about children and celiac children?  Celiac Disease does so much damage in babies, as the infant relies on its full digestive capacity to maintain growth in the first few years.  The child doubles its birth weight in six months and triples birth weight in a year,  In order to achieve this spectacular growth a child has to consume approximately ten per cent of body weight daily.  By contrast, an adult consumes approximately 3.5% of body weight daily.

Celiac Disease severely impairs the infants digestion, resulting in weight loss as an early sign.  Growth in height ceases after a few months.  Similarly, when the child is put on a gluten free diet, weight will precede resumption of growth.  The body effectively waits 2-3 months to see if good nutrition will be sustained before investing in growth.  Because the response is so dramatic, it is tempting to diagnose celiac children according to their symptoms.  However, many other conditions similarly improve with a gluten free diet and it is easy to be misled if you rely on symptoms alone.

There is continuing work on blood tests for anti-gladin and anti-endomysial antibodies.

However, at present these are only used as screening tests are only used as screening tests or to monitor for compliance with the diet.  As ion adults, it is imperative to confirm the diagnosis of celiac disease by intestinal biopsy.  The reasons are below.

• Proportions of the child Compared to the adults.  Most adults intuitively recognize a child at a distance because children's body proportions are very different from those of the adult.  The head and torso of the infant are proportionally much bigger than the limbs compared to an adult. This means that the working parts of the child occupy a much greater proportion of the body accounting for a baby's higher metabolism.  Babies breath more frequently, and the heart beats much faster than in an adult.  These factors contribute to the infant's relatively greater requirements for food and fluids.

Any dietary intervention has more powerful and serious effects on the young child.  Similarly, when illness interrupts feeding, babies get into trouble much more quickly.
A lot of this has special implications for the health care system.  Society is intuitively more nuturing of babies precisely because they are more fragile.  Children require special facilities that are more responsive including emergency rooms, laboratories and operating rooms in hospitals.  Sometimes these are provided in Children's Hospitals but it is important that these special needs be given consideration in your local community as well.

• Implications for Nutrition of Children  There are other implications of children's differences from adults which may be of interest.  A young child's need for calories relies on a richer diet where many of the calories are provided by fat.  Our society has discouraged high fats in adults to prevent heart disease.  However, infants and toddlers are very different from adults and require diets much higher in fat.  there are many unfortunate instances where children are subjected to low fat diets by well meaning parents  This is particularly inappropriate because children require fat in the diet for proper development of the brain and nervous system.  in our enthusiasm for the latest health fad, we must always question whether the same logic is right for children.
  

• Implications for children with Celiac Disease  All of this may be interesting but you might ask why this matters.  the first reason is that many individuals are first diagnosed with celiac disease in childhood when the condition is particularly dangerous.  As the child grows, the reaction to wheat or gluten products becomes less obvious convincing parents that the child grew out of celiac. 
  The truth is that a child diagnosed by the reaction to symptoms could represent one or two situations.  Either he/she never had celiac disease in the first place and is needlessly kept on the diet or the child is truly celiac but comes off the diet when he/she outgrows symptoms.  Either situation is inappropriate.  A definitive diagnosis of Celiac Disease presently needs to be proven by biopsy rather than intuition.
  Many children are still wrongly put on restrictive diets by untrained but well unintentioned professionals.  Sometimes, this is done by doctors or nurses who don't have an appreciation of the special needs of infants and children.  It is an ongoing goal of the Canadian Celiac Association to support the continuing education of health professionals and this campaign is working.

However, increasingly, non professionals such as naturopaths, chiropractors and well intentioned neighbours are giving diet advice without appropriate training.  Inappropriate dietary restrictions are better tolerated by adults who have completed growing.  However, dietary advice in youngsters is a potentially more dangerous proposition. Celiacs have a responsibility to share this message with the public.  Presently, qualified dieticians on whom Celiacs depend are being challenged by other with an interest in diet

Celiacs have a special interest in seeing that individuals must have appropriate training and qualifications before givein advice to the public.  This is important for all, but especially true when it comes to babies and children.

In summary, celiac disease is very dramatic in the young child.  Children are particularly  vulnerable at this time.  However, we can't yet rely on symptoms to diagnose the condition and should discourage others from doing so because the natural result will be poorer health both for the child with true celiac disease as well as children without the condition.