When do babies grow out of wheat allergies?

Celiac disease is an autoimmune disorder that affects the digestive system. If your child has celiac disease, his immune system reacts to gluten, which results in the destruction of the lining of his small intestine. As a result, his body is unable to absorb nutrients from the food that passes through the damaged small intestine, and he may become malnourished.

Gluten is a protein found in foods that contain these grains:

How common is celiac disease in children?

About 1 in 100 children have celiac disease, making it one of the most common genetic disorders. However many people go undiagnosed. Scientists believe that the disease is becoming more common, but it's not entirely clear why.

At what age does celiac disease appear?

Celiac symptoms can appear as early as 6 months of age, after you start introducing your baby to solid foods that contain gluten. However, symptoms may not be noticeable until adulthood, and some children with celiac disease do not show symptoms at all. Sadly, the majority of people living with celiac disease go undiagnosed.

Are some children more at risk for celiac disease?

Your child is at increased risk for celiac disease if she has:

• A parent or sibling with celiac disease (if this is the case, your child has about a 1 in 10 chance of having celiac disease)
• Down Syndrome
• Type 1 diabetes
• Selective IgA deficiency (an immune system condition)
• Turner syndrome
• Williams syndrome
• Autoimmune thyroiditis

Signs and symptoms of celiac disease in children

Symptoms of celiac disease vary by age and from one child to another. Below are common symptoms by age group.

Babies and toddlers

• Vomiting
• Bloated tummy
• Fussiness
• Poor growth
• Gas
• Foul-smelling diarrhea

School-age kids and teens

• Stomach ache
• Bloated tummy
• Diarrhea
• Constipation
• Trouble gaining weight, or weight loss
• Delayed puberty
• Skin rashes

If left untreated, children with celiac disease can develop complications

Keep in mind that about 20 percent of people with celiac disease do not show any signs at all. Even without symptoms, your child can still suffer long-term health consequences if celiac disease goes untreated. These consequences can include iron-deficiency anemia, malnutrition, weakened bones, short stature, infertility, thyroid disease, multiple sclerosis and intestinal cancer. It's important to get your child tested if she is at risk for celiac disease.

What's the difference between celiac disease, wheat allergy, and gluten sensitivity?

Celiac disease, gluten sensitivity, and wheat allergy are often confused with one another, because they all involve an intolerance of wheat proteins, and many of the symptoms look alike. But they're very different conditions that are diagnosed and managed in distinct ways.

Celiac disease is a serious but treatable autoimmune disorder. As long as your child completely avoids gluten, she shouldn't experience any symptoms or damage to her small intestine.

Wheat allergy involves a different part of the immune system. If your child has a wheat allergy, her immune system has identified wheat proteins as an allergen. Whenever a child eats foods or breathes in substances that contain wheat, she has an allergic reaction that causes her body to release histamines.

If your child has a wheat allergy, you may notice classic food allergy symptoms, such as:

• Hives
• Swelling or itching of the lips
• Rash
• Itching
• Wheezing
• Diarrhea
• Nausea
• Vomiting

Symptoms appear within minutes or hours, and in some cases, can quickly become life threatening.

Gluten sensitivity, also called “non-celiac gluten sensitivity” or “wheat intolerance syndrome” isn't a food allergy, and people with this condition do not test positive for celiac disease. In fact, there is no specific test for gluten sensitivity. However, it can cause symptoms similar to those of celiac disease that improve on a gluten-free diet. Like celiac disease, some research indicates gluten sensitivity may also cause mild damage to the small intestine. Unlike celiac disease, gluten sensitivity doesn't appear to be genetic. Some children with gluten sensitivity may also carry the diagnosis of irritable bowel syndrome (IBS).

Scientists aren't sure whether gluten is the true culprit behind gluten sensitivity. Several studies suggest it may be caused by foods that are high in a group of carbohydrates known by the acronym FODMAP (fermentable, oligo-, di-,mono-saccharides, and polyols). These carbs – which include dairy, wheat, beans, and certain sweeteners, fruits, and veggies – tend to be hard to digest and may ferment in the gut and cause abdominal distress in people who are sensitive to them.

Talk with your child's doctor if you suspect he has celiac disease or another type of gluten-related problem. Your pediatrician may:

• Do a physical exam
• Ask questions about symptoms and your family medical history
• Order blood tests for celiac disease. For the blood tests to be accurate, make sure that your child continues to eat as he normally does. Don't eliminate foods that contain gluten or wheat unless your doctor specifically asks you to.
• Refer you to an allergist for a skin prick test, blood tests, or a food challenge, if a wheat allergy is suspected. Your child might be asked to eat a small amount of wheat under medical supervision and be observed for an allergic reaction.
• Refer you to a pediatric gastroenterologist, if she suspects a gluten problem. This doctor may order more blood tests and do an endoscopy, passing a long, thin tube through the mouth and stomach into the small intestine and taking a tiny sample of tissue. If the sample reveals damage to the small intestine, your child will be diagnosed with celiac disease.

Gluten sensitivity is more difficult to diagnose. Currently, there aren't any tests available. If your child shows symptoms that suggest a gluten issue but wheat allergy and celiac disease have been ruled out, your doctors may suspect gluten sensitivity. Your gastroenterologist may recommend trying a gluten-free or low-FODMAP diet plan. If your child's symptoms improve, the answer is probably gluten sensitivity.

You may be tempted to avoid an endoscopy and just go gluten-free if you suspect that your child has celiac disease, but it's crucial to get a diagnosis first. If your child does have celiac disease, you'll need help managing his diet safely and his doctor will need to monitor intestinal damage and bone loss.

Celiac disease tends to run in families, so it's important for parents and siblings of a diagnosed child to be screened as well.

How is celiac disease treated in children?

If your child has been diagnosed with celiac disease, you'll need to make sure that he avoids all foods containing gluten for the long term. The good news is that after eliminating gluten, his symptoms should start to disappear, and his small intestine should heal within a few months.

How are wheat allergies and gluten sensitivity treated in children?

Wheat allergy treatment

Unlike kids with celiac disease, many children with a wheat allergy can tolerate other grains like rye and barley. It's a bit easier to follow a wheat-free diet than a strict gluten-free diet. Be sure to talk with your child's allergist about the foods your child can safely eat.

Gluten sensitivity

It's unclear whether people with gluten sensitivity need to avoid gluten as strictly as people with celiac disease. While research continues, experts recommend that gluten sensitive patients work closely with their doctor and dietitian to develop a personalized food plan that helps them stay symptom-free.

Can children outgrow celiac disease?

Unfortunately, people don't outgrow celiac disease – your child will need to be on a strict gluten-free diet for his entire life.

On the other hand, most children outgrow wheat allergies by the time they reach adulthood. Similarly, non-celiac gluten sensitivity may be a temporary condition. Therefore, experts recommend trialing gluten again after 1 to 2 years of adhering to a gluten-free diet.

What foods contain gluten?

To follow a gluten-free diet, your child will need to stay away from wheat, rye, and barley, as well as additives that may contain gluten. Most pastas, pizza, crackers, cereals, breads, and baked goods are made using these grains. Common gluten-containing ingredients include:

• Wheat and wheat varieties such as spelt, kamut, durum, graham, and semolina
• Wheat bran, wheat starch, wheat germ, cracked wheat, hydrolyzed wheat protein
• Barley
• Rye
• Triticale
• Malt (unless it's derived from corn)

Oats are naturally gluten-free, but many oat products are contaminated with gluten during processing. So it's worth experimenting with oats that are labeled gluten-free, but be aware that researchers have found that some celiac patients can't tolerate even those oat products.

Keep in mind that, while gluten-free diets have become trendy in recent years, it's not necessary to adopts a gluten-free diet if your child does not have celiac disease or another gluten-related disorder. Doing so could lead to your child missing out on key nutrients that are important for healthy growth and development.

How to go gluten-free if your child has a gluten disorder

Diagnosis can be a relief, but for many families, going gluten-free is a big lifestyle change. Grocery shopping, managing a gluten-free household, and eating out can all feel daunting, but there are some good guidelines and resources for parents.

• Consult your child's doctor or dietitian to develop a food plan. Just because a food is gluten-free does not mean it's healthy. It's important to make sure your child doesn't miss out on any essential nutrients. Your dietitian can help you develop a nutritious eating plan that fits your budget and lifestyle, and can also give you recipes and suggest substitutes for your child's favorite foods.
• Learn to read food labels. When you're shopping, check ingredients and avoid any products that include gluten-containing grains. Be wary of prepared and processed foods. Gluten can be found lurking in unexpected places, such as store-bought stews and soups, soy sauce, processed meats like hot dogs and cold cuts, salad dressings, medications, vitamins, and even lip balms.
• Choose naturally gluten-free ingredients over manufactured products. Gluten-free bread, cookies, and crackers tend to be more expensive and have added sugars, sodium, or fat to make them taste better. Whole foods such as meat and poultry, fish, fruit, vegetables, most dairy, and nuts are naturally gluten-free and healthier for your family.
• Foods labeled "gluten free" should be safe for your child. All products marked "gluten-free," "without gluten," "no gluten," or "free of gluten" must either be naturally gluten-free or have gluten levels of less than 20 ppm (parts per million) in order to comply with the U.S. Food and Drug Administration's (FDA) current rules. A gluten level below 20 ppm is low enough to be tolerated by most celiac patients and is also the lowest level that can be detected using scientific tools. If you're not sure how much gluten is in a food product, don't let your child eat it.
• Check ahead for gluten-free options when eating out. Before visiting a restaurant, check online or call ahead to see whether they offer gluten-free options. If a menu states that something is gluten-free, the restaurant must comply with the FDA's definition. Check with the National Celiac Association or one of their local support groups for a list of restaurants that offer gluten-free menus or dishes.
• For school lunches, ask the principal about your options. Public schools are required by law to make reasonable meal accommodations for celiac patients on a gluten-free diet or kids who are at risk of having a life-threatening allergic reaction to wheat. Your child's doctor will need to provide confirmation of her condition. If you don't trust the cafeteria, however, you might want to pack your child's lunch.
• For birthday parties and play dates, your child might feel left out if she can't eat what others are enjoying. Talk to her beforehand, and provide a special meal and dessert for her. Most parents will understand.

For a list of foods to eat and avoid, tips on gluten-free food preparation, and advice on dining out, see the Gluten-Free Diet Guide for Families, by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

GI Kids: Children's digestive health information for kids and parents, by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

Celiac Disease Foundation: Overviews of celiac disease and treatment, practical diet tips, and support programs for children and young adults with celiac disease. Recommended by the American Gastroenterological Association.

National Celiac Association: A more technical and scientific website for celiac patients. Contains detailed information about celiac testing as well as gluten-free product lists and recipes. Recommended by the American Gastroenterological Association.

American Academy of Allergy, Asthma, and Immunology: A library of articles about food allergies, including recipes, anaphylaxis action plans, and information on the difference between food allergy, celiac disease, and gluten sensitivity.