What is coeliac disease?

Coeliac disease is an autoimmune disease. It happens when the body has an abnormal immune response to gluten, a protein found in wheat, rye and barley.

When people with coeliac disease eat gluten, their bodies mistakenly attack the lining of their small intestine. When the lining of the small intestine is damaged, it’s hard for people to digest and absorb nutrients properly. This can affect physical health, weight and growth.

Coeliac disease can develop at any age. In children, it can be any time after solids containing gluten are introduced.

Coeliac disease symptoms in children

Coeliac disease symptoms and signs can range widely.

If your child has coeliac disease, their symptoms and signs might include:

• nausea, vomiting, diarrhoea or constipation
• poor appetite
• stomach pain
• bloating
• mouth ulcers
• anaemia
• delayed growth or late puberty
• weight loss
• tiredness and irritability.

When to see a doctor if your child has coeliac disease symptoms

You should take your child to see your GP if your child has any of the symptoms above and you don’t know why, or the symptoms last for more than 2 weeks.

How is coeliac disease diagnosed?

If you’re concerned about your child’s symptoms or you think your child might have coeliac disease, getting a proper medical diagnosis is important.

The first step in diagnosing coeliac disease is a blood test. This test measures specific antibodies in your child’s blood. If your child has a high level of these antibodies, it might mean that they have coeliac disease. Your GP will then refer you to a gastroenterologist.

The gastroenterologist will do more tests to confirm whether your child has coeliac disease.

These tests usually include a gastroscopy. In a gastroscopy, a flexible tube is passed through your child’s mouth and into their small intestine, where small tissue samples are taken. It’s a safe and quick procedure. It’s done under a general anaesthetic and takes about 20 minutes.

Your child should keep eating bread, pasta and other foods that contain gluten until all the coeliac tests are finished. There needs to be enough gluten in your child’s diet for the tests to accurately check how your child’s body is reacting to the gluten.

Coeliac disease treatment

There’s currently no cure for coeliac disease. But it can be managed with a strict lifelong gluten-free diet.

Once your child stops eating gluten, their small intestine can heal and they should start to feel better, usually within a few days or weeks.

If your child is low on some nutrients, your health professional might recommend that your child takes a supplement for a few weeks or months.

When people with coeliac disease don’t follow a strict gluten-free diet, it can lead to long-term health problems including malnutrition, lactose intolerance, osteoporosis, arthritis, liver disease, epilepsy, infertility and some gastrointestinal cancers.

Gluten-free diets and coeliac disease

Sticking to a gluten-free diet at all times is very important. This is because even tiny amounts of gluten in your child’s diet can prevent the small intestine from healing completely.

Removing foods with gluten from your child’s diet

Gluten is found in wheat, rye and barley, so you can start by cutting out foods made with these ingredients. These foods might include:

• biscuits
• bread
• breakfast cereals
• cakes
• crumbed, fried or battered food
• dumplings
• pasta and some noodles
• pastry
• pizza bases
• sauces – for example, soy sauce and pre-made stir fry sauces.

Keeping gluten-free food separate at home

In your home, it’s important to keep gluten-free foods separate from gluten-containing foods, so your child with coeliac disease doesn’t accidentally eat gluten. Here are tips:

• Prepare and store all gluten-free foods away from foods with gluten.
• Use separate chopping boards and utensils when preparing or cooking gluten-free foods.
• Clean utensils and appliances that might have gluten-containing foods or crumbs on them.
• Consider a separate toaster for gluten-free breads.
• Always use clean utensils for condiments or spreads, or keep separate containers.

Reading labels on all foods

There can be hidden gluten in many foods, including sauces and soups. There can also be hidden gluten in non-food products too, like medicines, supplements and playdough. This means it’s very important that both you and your child read food labels.

Most packaged foods must list ingredients with gluten on the ingredient list. You can also look out for the crossed grain logo on food packages. This means the food is OK for people with coeliac disease.

Taking care when your child eats away from home

Eating out is an important social activity that your child can still enjoy. But you and your child need to take extra care so that your child doesn’t mistakenly eat foods with gluten.

Many restaurants flag gluten-free items on their menus. But it’s still a good idea to let staff know that your child can eat only gluten-free food. And when the food arrives, it’s good to check again that it’s gluten free.

It’s also important to let your child’s preschool or school know that your child can’t have foods with gluten.

Looking for gluten-free alternatives

You can make or buy alternatives to most foods with wheat, rye, barley and oats. And you can check out gluten-free cookbooks for new menu ideas.

It’s best for your child to avoid oats. Oats can be contaminated with gluten if they’re grown and processed at the same facilities as wheat, rye or barley. Also, some people with coeliac disease can’t tolerate oats, even if they’re uncontaminated. You can talk to your health professional about trying specially produced pure oats.

Support for children with coeliac disease

If your child has coeliac disease, they can still have a balanced, nutritious and interesting diet.

It’s important to talk with a dietitian about managing your child’s diet. The dietitian can also recommend reliable recipes, cookbooks and websites.

You can also get support by joining an online or face-to-face support group. Some people pay to join Coeliac Australia. And you can call Coeliac Australia’s helpline on 1300 458 836 for information about coeliac disease and how to manage it.

Coeliac disease causes

Coeliac disease can run in families. Parents can pass on genes that make it possible for their children to develop coeliac disease. If you, your child’s other parent or one of your child’s siblings has coeliac disease, your child has a 10% chance of also having the condition.

Environmental factors probably play a role in the development of coeliac disease too. For example, some types of viral gastroenteritis and some medicines might make it more likely that your child will get coeliac disease.

If you or someone in your family has coeliac disease, it’s a good idea to get your child tested for this condition too.