What is coeliac disease?
Coeliac disease is an autoimmune disease. It is caused by an abnormal reaction by your child's immune system to gluten. Gluten is a protein in wheat, barley and rye. Your child's immune system mistakes gluten as a threat to the body. In an attempt to protect the body from the threat, the immune system creates special gluten-fighting antibodies to fight it.
If your child has coeliac disease, these gluten-fighting antibodies damage the lining of the small bowel.
Your child's small bowel is lined with tiny finger-like projections, called villi. Villi break down and absorb nutrients in food. In coeliac disease, gluten damages the villi so they become flat and the surface area of the bowel decreases. This interferes with the absorption of nutrients from food. This means your child may not absorb enough vitamins (such as folic acid) and minerals (such as iron and calcium).
These diagrams show where the small intestine is, and the damage that happens to the small intestine lining in coeliac disease.
How common is coeliac disease?
About 1 in 70 New Zealanders may have coeliac disease - up to 80 percent of them are unaware they have the condition. It is more common in people of European descent but can affect anybody. It can affect children of any age after they start eating foods containing gluten.
Close relatives of someone with coeliac disease have an increased risk of developing the disease. Coeliac disease can also develop in children with other autoimmune conditions such as type 1 diabetes and thyroid disease. It is also more common in children with chromosomal conditions such as Down syndrome.
What are the symptoms of coeliac disease?
Children with coeliac disease may have some of the following symptoms but may also have none at all:
large, bulky, smelly poo
poor weight gain
weight loss in older children
low iron and/or anaemia
uncomfortable and swollen abdomen
nausea and vomiting
tiredness and/or irritability
How do doctors diagnose coeliac disease?
If you think your child has coeliac disease, talk to the doctor. Tell your doctor if a relative has coeliac disease.
Your child may need a test for coeliac disease. Diagnosing coeliac disease accurately is important because coeliac disease is a life-long condition.
Coeliac serology blood test
Coeliac serology measures gluten-fighting antibodies in the blood to see if your child has coeliac disease. These antibodies are often higher in people with untreated coeliac disease. Your child must be eating gluten for about a month before the test.
Your doctor may also check for some vitamin and mineral levels in your child's blood, particularly iron.
If coeliac serology is positive, your doctor will arrange for your child to have further tests. These can include:
another blood test
a gastroscopy and biopsy
Some children may be able to get a coeliac diagnosis without a biopsy. Your doctor will talk with you about this.
A blood test called HLA gene testing
Not all children need HLA testing. It can be useful if there is uncertainty about your child's diagnosis. The gene test alone cannot diagnose coeliac disease.
Your child may need a biopsy.
To have a biopsy, your child needs an endoscopy. This is a simple day procedure. Your child will need an anaesthetic. The doctor will use a flexible tube with a camera attached to its end (endoscope). The doctor will feed the tube through your child's mouth into their stomach and then the small bowel. The doctor will take several tiny samples (biopsies) of your child's small bowel.
Laboratory staff will then examine the biopsies under a microscope to confirm whether your child has coeliac disease. It can take a week or two to get the results.
What is the treatment for coeliac disease?
The only treatment for coeliac disease is for your child to follow a strict gluten-free diet. This allows the villi in the bowel to regrow. After removing all gluten from their diet, your child will return to normal health over a few months.
If your child has had low levels of iron or other vitamins or minerals, they may need to take a supplement until their gut heals.
What does eating gluten-free involve?
A gluten-free diet means removing foods that contain gluten including wheat, barley, rye and from your child's diet. Oats do not contain gluten but may be contaminated and your dietitian will instruct you in regards to this.
Your child with coeliac disease needs to be on a gluten-free diet for life. Your child's diet needs to exclude all sources of gluten. Eating small amounts of gluten can cause further damage to your child's gut and affect their growth even though it may not lead to symptoms. It is important to meet with a dietitian to learn and get the right advice about a gluten-free diet.
You will need to replace many common foods with gluten-free alternatives.
You will also need to learn to identify hidden sources of gluten, particularly in commercially packaged food.
Should my child be on a gluten-free diet if they don't have coeliac disease?
No. Children shouldn't be on a restrictive diet if they don't need to be.
How can I help my child live with coeliac disease?
Explaining coeliac disease to your child
Children can adapt very quickly to a new diet. They may have been feeling sick for some time so they often feel better on their new diet.
Children book explaining coeliac disease- The Trouble That Jack Had .
Getting the whole family involved
It's important to explain coeliac disease to the whole family - including sisters and brothers. You might like to go through your cupboards and label all gluten-free products with a smiley face sticker and products that are not gluten-free with a warning sticker to make sure everyone gets the message.
Cooking for the whole family
When cooking for the family, you can make many dishes gluten-free by simply changing certain ingredients (such as stock cubes). It is important to take sensible steps to prevent contamination with gluten-containing foods in the kitchen. This especially applies to toasters. Children with coeliac disease should have their own toaster.
If you are ever unsure about what food is gluten-free, Coeliac New Zealand has a range of resources - these can help you identify gluten-free products.
Going for regular check-ups
It is important for your child to have regular check-ups with their dietitian and doctor. This is to make sure that your child recovers as expected. Your doctor will keep an eye on your child's growth. They may also do a blood test to make sure the coeliac antibody levels have returned to normal. It may take time (sometimes over a year) for the antibody levels to return to normal. Checking the antibody level can be helpful to make sure that your child is sticking to their gluten-free diet.
Talking to your child's school
Make sure your child's school or day-care know your child has coeliac disease. Children often share lunch boxes. Also, some play material (such as play-dough) contains gluten.
Where can I go for support for my child with coeliac disease?
Contact Coeliac New Zealand for support and advice.