Celiac disease — a disorder of the small intestine caused by an inappropriate immune response to wheat, barley and rye — is more common in children than most people realize, according to Atiye Nur Aktay, MD, Department of Pediatrics, Division of Gastroenterology at UH Rainbow Babies & Children’s Hospital.

“Celiac disease is an autoimmune disease, not an allergic reaction to wheat products, which is a different entity,” she says.

Kids who are most susceptible to this condition include patients with Down syndrome, type 1 diabetes, autoimmune thyroid problems or a family history of a firstdegree relative with celiac disease. In addition, children with Turner syndrome, osteoporosis or unexplained anemia are also at risk.

“Any child who falls into one of these categories, or who has gastrointestinal symptoms including abdominal pain, diarrhea, bloating and failure to thrive needs to be screened,” says Dr. Aktay. “However, many young patients are not diagnosed until gastrointestinal symptoms manifest.”

Other nongastrointestinal signs of celiac disease include rashes on the extremities, dental enamel changes, short stature and elevated liver enzymes. Symptoms for celiac disease typically present between 16 to 24 months of age, after a child is exposed to foods like cereal, bread and pasta containing gluten — a type of protein found in some grains used to make these products. However, the condition, marked by gastrointestinal symptoms, may surface at any age.

If a parent or guardian suspects that his or her child has celiac disease, the family’s primary care physician or pediatrician can order the appropriate blood work. If necessary, the child can be referred to a pediatric gastroenterologist for further testing.

Dr. Aktay explains that patients are screened through a simple blood test. If the test is positive, a diagnosis is confirmed with a small bowel biopsy obtained from the child.

“Once the diagnosis is established, treatment includes a gluten-free diet, not medication,” says Dr. Aktay. Children and their families work with a pediatric dietitian experienced in counseling young patients to make appropriate food choices.

“Many foods that children like contain wheat, barley and rye,” she says. “Compliance to the gluten-free diet is difficult, but patients who follow it lead a normal, active life.”