First described by a Roman physician in 250AD, coeliac disease affects 1 in 1500 people in the UK. Dr Kerry Robinson describes the diagnosis and treatment for children

Parents often encounter coeliac disease for the first time when they start to wean their baby off milk onto solids. Some babies react to foods containing gluten – a substance found in wheat, rye, oats and barley. Proteins containing gluten trigger an immune reaction that damages the delicate lining of the intestine and causes serious problems with digestion. Diarrhoea or bulky stools are the main symptoms, but babies with coeliac disease can’t absorb essential vitamins and minerals from foods if they contain gluten and so in the long term both their growth and development can be affected.

What happens in the intestine?

The lining of the intestine is usually full of leaf-like folds called villi. These villi are richly coated with digestive enzymes. If a child with the coeliac genetic make up eats gluten, the villi get destroyed. This also destroys the digestive enzymes and, as a result, the intestines can no longer digest food properly.

Other signs and symptoms

If a child with coeliac disease eats foods containing gluten, they can’t absorb vital vitamins and minerals, so stored sources of body energy get used instead. As a result, the child becomes very thin with flat buttocks and a bloated tummy. They can become listless and tired and may also be small for their age. They can also suffer calcium deficiency, which affects the development and structure of their bones.

We don’t know why some people develop this immune reaction and some don’t

We do know that coeliac disease runs in families. Close relatives of someone with coeliac disease have a five to10% chance of developing the problem themselves and it doesn’t always start in childhood. In fact most cases of coeliac disease are diagnosed in adults between the ages of 30 and 45.

Exclude gluten from the diet and the symptoms disappear

This can take some time and has to be a lifelong commitment but the effect is dramatic. Wheat starch can be specially manufactured to remove the gluten component and in the UK certain gluten products (including bread) are available on prescription from the chemist. You should check this with your GP.

Children with coeliac disease can eat:

• Rice, potato, maize and corn
• Fresh fruit and veg
• All hard cheeses
• Sauces thickened with cornflour

• Anything containing wheat, barley, rye or oats. This includes any food containing ordinary flour such as bread, cakes, pastries, puddings and pies.
• Products containing thickening agents which may use starches and gluten
• Prepared meats including luncheon meat and sausages
• Some ice-creams
• Soy sauce

You must also be careful with medicines. Tablet fillers can contain gluten and some cough medicines contain alcohol which can be gluten derived.

As children get older they’re under pressure to conform and try different foods. Anything that sets them apart from the pack is difficult to cope with but if a child with coeliac disease does start to eat foods containing gluten, the damage to the intestine will return. They will get diarrhoea and suffer weight loss with the consequent deficiencies of vitamins and minerals. So parents do need to make sure that children understand how important it is to stick rigidly to the regime.

Helpful Organisations:

The Coeliac Society in the UK is an excellent and active organisation providing information and advice about coeliac disease. They have local meetings all over the country and provide recipes and lists of foods that can and cannot be eaten.

Another very useful organisation for people with coeliac disease (and indeed almost any other long term illness or syndrome) is an organisation called Contact a Family. They provide information but also support and give contact names and numbers of people with the condition who are willing to share their experiences with other sufferers.