How to manage pediatric celiac disease
Managing celiac disease can be challenging for patients of all ages, but particularly for children who not understand what their diet requires.
A new report from a group of researchers headed by John Snyder, MD, Children's National Health Systems, Washington, DC, presents new guidelines, published in Pediatrics, for pediatricians to use in the ongoing management of pediatric celiac patients based on evidence-based best practices.
“Studies demonstrate that children who are seen on a regular basis for their celiac disease and who are taught about how to manage their disease cope better with celiac disease and the gluten-free diet. Parents play a big role in the teaching,” says J Decker Butzner, MD, FRCPC, clinical professor in the department of Pediatrics at Alberta Children’s Hospital in Calgary, Canada, chair of the Canadian Celiac Association, and co-author of the study.
Celiac disease is an autoimmune disorder in which the body reacts poorly to gluten—a protein found in wheat, rye, and barley products. The reaction results in damage to the small intestine leading to nutritional malabsorption. The best management strategy is strict adherence to a gluten-free diet, but this can be a challenge for children, and ongoing evaluation is needed to determine whether children and families have achieved compliance with the diet in order to decrease the risk of complications from the disease.
Multiple evidence-based North American and European guidelines have been created to address diagnoses of celiac disease in children, but relatively little evidence-based information is available to assist clinicians with the ongoing management of these children, Butzner says. For this study, 7 experts in pediatric celiac disease reviewed the existing literature and developed recommendations to improve compliance and outcomes for the management of pediatric celiac disease. They developed a list of best practices that includes the evaluation and follow-up of bone health; hematologic conditions; endocrine associations; liver injury and need for evaluation of hepatitis B vaccination status; and growth and nutrition, according to Butzner.
At the time of diagnosis, all children with celiac disease should have a complete blood count and ferritin test to screen for nutritional anemias—particularly iron, folate, or B12 deficiencies, according to the guidelines. Iron-deficiency anemia or low iron stores are common, and children who present with poor growth or diarrhea, especially with weight loss, should be screened for other nutrient deficiencies. They should also be assessed for elevated liver enzymes and hypothyroidism as these may occur in children with celiac disease. If abnormalities are identified, ongoing evaluation needs to be conducted until they are corrected, Butzner says.
After diagnosis, celiac disease should be managed through adherence to a strict gluten-free diet, and families who are new to the celiac diagnosis are advised to meet with a dietician to offer education on label reading for hidden sources of gluten and safe food preparation.