What is gluten? The Child with Celiac Disease:

The Child with Celiac Disease:
What Every Parent Should Know
Thomas J. Sferra, MD, a pediatric gastroenterologist
and Chief of the Division of Pediatric Gastroenterology,
Hepatology & Nutrition at University Hospitals Rainbow
Babies & Children’s Hospital, says that celiac disease
– a disorder of the small intestine caused by an
inappropriate immune response triggered by gluten,
a protein found in wheat, rye and barley – is more
common in children than most people realize.
“Celiac disease is an autoimmune disorder, not an
allergic reaction to wheat products. A wheat allergy is
a different entity,” he says.
Children with celiac disease can develop a wide
variety of symptoms when exposed to gluten. These
symptoms commonly include decreased appetite,
abdominal pain, diarrhea, bloating, and weight
loss or poor growth. Rashes on the extremities,
dental enamel changes, anemia, osteoporosis (bone
thinning), and elevated liver enzymes, also, might
occur in those with this disease.
Symptoms and signs of celiac disease typically
present between 16 to 24 months of age, after a
child is exposed to cereal, bread, pasta and other
foods containing gluten. However, the condition
may surface at any age.
The risk of developing celiac disease is increased
in individuals with a close relative (e.g., sibling or
parent) affected by this disease. Also, children with
type 1 diabetes, autoimmune thyroid disease, Down
syndrome, Turner syndrome, Williams syndrome and
IgA deficiency have an increased susceptibility to
celiac disease.
“Any child who falls into one of these categories or
has symptoms associated with celiac disease should
be evaluated for this disorder,” says Dr. Sferra.
If a parent or guardian suspects his or her child has
celiac disease, the family’s primary care physician
What is gluten?
Gluten is a type of protein found in
wheat, barley and rye. Most baked goods
like breads and pastries contain gluten,
because it gives elasticity to dough and
makes it appear stretchy. Other foods,
including cereals, noodles and pastas, also
contain gluten.
Although gluten is typically listed on
packaging labels, consumers may not know
that the ingredient is sometimes used in
medications, puddings and beverages.
Fortunately, gluten-free product alternatives
are available at most grocery stores for
patients who are unable to eat specific
cereal grains.
or pediatrician can initiate an evaluation. If
necessary, the child will be referred to a pediatric
gastroenterologist for further testing.
Dr. Sferra explains that patients are evaluated initially
through a simple blood test. If the test is positive,
a diagnosis is confirmed with a small bowel biopsy.
“Once the diagnosis is established, treatment is not a
medication, but a gluten-free diet.”
Children and their families work with a pediatric
dietitian experienced in counseling young patients on
staying healthy through appropriate food choices.
“Many foods children like contain gluten” he says.
“Compliance with the gluten-free diet is difficult, but
patients who follow it lead a normal, active life.”
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Dr. Sferra sees an increase in the number of patients
diagnosed with celiac disease and attributes the
higher numbers to proactive screening in young
patients who may display no overt symptoms, but
have a first-degree relative with the disease.
He says the triggers for celiac disease have not
yet been identified. However, infection or other
environmental factors may play a role in the onset
of the condition. “There is definitely a genetic
component, but it is unknown as to why some
children develop the disease, and others do not.”
Dr. Sferra stresses the importance of increasing
celiac disease awareness. “If it is left untreated,
celiac disease can lead to lifelong symptoms and
nutritional deficiencies.”
Thomas J. Sferra, MD
Martin and Betty Rosskamm Chair
in Pediatric Gastroenterology
UH Rainbow Babies & Children’s Hospital
Associate Professor
Case Western Reserve University
School of Medicine
The UH Rainbow Babies & Children’s Hospital
pediatric gastroenterologists see patients at
the following locations:
UH Rainbow Babies & Children’s Hospital
11100 Euclid Avenue
Cleveland, Ohio 44106
UH Landerbrook Health Center
5850 Landerbrook Drive
Mayfield Heights, Ohio 44124
UH Medina Health Center
4001 Carrick Drive
Medina, Ohio 44256
UH Westlake Health Center
960 Clague Road
Westlake, Ohio 44145
Firelands Regional Medical Center
1912 Hayes Avenue
Sandusky, Ohio 44870
Call 216-UH4-KIDS
To make an appointment with a UH Rainbow Babies &
Children’s Hospital pediatric gastroenterologist,
call 216-844-5437 or visit RainbowBabies.org.
There’s only one Rainbow.
© 2012 University Hospitals
RBC 00606